Case Reports in Cardiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. A Rare Case of Complete Stent Fracture, Coronary Arterial Transection, and Pseudoaneurysm Formation Induced by Repeated Stenting Mon, 12 Oct 2015 09:05:04 +0000 This report describes a rare asymptomatic case of complete stent fracture, coronary arterial transection, and pseudoaneurysm formation in response to repeated stenting. The proximal and distal ends of transected coronary artery were closed, and distal bypass was performed. Coronary arterial transection can occur in patients with repeated stenting as a long-term adverse event. Fumiaki Nakao, Masashi Kanemoto, Jutaro Yamada, Kazuhiro Suzuki, Hidetoshi Tsuboi, and Takashi Fujii Copyright © 2015 Fumiaki Nakao et al. All rights reserved. Comment on “Takotsubo Cardiomyopathy: A New Perspective in Asthma” Mon, 12 Oct 2015 08:00:49 +0000 John E. Madias Copyright © 2015 John E. Madias. All rights reserved. Right Ventricular Outflow Tract Tachycardia with Structural Abnormalities of the Right Ventricle and Left Ventricular Diverticulum Mon, 05 Oct 2015 13:05:06 +0000 A 43-year-old woman presented to the emergency room with a sustained ventricular tachycardia (VT). ECG showed a QRS in left bundle branch block morphology with inferior axis. Echocardiography, ventricular angiography, and cardiac magnetic resonance imaging (CMRI) revealed a normal right ventricle and a left ventricular diverticulum. Electrophysiology studies with epicardial voltage mapping identified a large fibrotic area in the inferolateral layer of the right ventricular wall and a small area of fibrotic tissue at the anterior right ventricular outflow tract. VT ablation was successfully performed with combined epicardial and endocardial approaches. Bortolo Martini, Nicola Trevisi, Nicolò Martini, and Li Zhang Copyright © 2015 Bortolo Martini et al. All rights reserved. Reversible Myocarditis and Pericarditis after Black Widow Spider Bite or Kounis Syndrome? Mon, 05 Oct 2015 11:36:48 +0000 Clinical manifestation of black widow spider bite is variable and occasionally leads to death in rural areas. Cases of myocarditis and pericarditis after black widow spider bite are rare and the associated prognostic significance is unknown. Kounis syndrome has been defined as an acute coronary syndrome in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults that manifests as vasospastic angina or acute myocardial infarction or stent thrombosis. Allergic myocarditis is caused by myocardial inflammation triggered by infectious pathogens, toxic, ischemic, or mechanical injuries, such as drug-related inflammation and other immune reactions. A 15-year-old child was admitted to the emergency department with pulmonary edema after spider bite. ST segment depression on ECG, elevated cardiac enzymes and global left ventricular hypokinesia (with ejection fraction of 22%), and local pericardial effusion findings confirmed the diagnosis of myopericarditis. After heart failure and pulmonary edema oriented medical therapy, clinical status improved. Patient showed a progressive improvement and LV functions returned to normal on the sixth day. Myopericarditis complicating spider bite is rare and sometimes fatal. The mechanism is not clearly known. Alpha-latrotoxin of the black widow spider is mostly convicted in these cases. But allergy or hypersensitivity may play a role in myocardial damage. Mehmet Yaman, Turkan Mete, Ismail Ozer, Elif Yaman, and Osman Beton Copyright © 2015 Mehmet Yaman et al. All rights reserved. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report Wed, 30 Sep 2015 09:44:58 +0000 Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication. Yakup Alsancak, Burak Sezenoz, Sedat Turkoglu, and Adnan Abacı Copyright © 2015 Yakup Alsancak et al. All rights reserved. Double Ventricular Responses Leading to Reversible Cardiomyopathy as Late Complication after Slow-Pathway Ablation Wed, 30 Sep 2015 08:01:01 +0000 Double ventricular response is a rare arrhythmia that results from simultaneous antegrade conduction over the fast and slow pathways of AV node. Double ventricular responses may lead to arrhythmia-related cardiomyopathy. As far as we know, there is not any reported reversible cardiomyopathy development that resulted from double ventricular responses to one atrial impulse after slow pathway ablation. We report a unique case of double ventricular response cardiomyopathy that has been developed 5 years after slow pathway ablation. Umut Celikyurt, Meinrad Gawaz, Juergen Schreieck, and Peter Seizer Copyright © 2015 Umut Celikyurt et al. All rights reserved. Pulmonary Vein Stenosis in a Newborn: A Commonly Overlooked Diagnosis Sun, 20 Sep 2015 14:19:07 +0000 The diagnosis of primary pulmonary vein stenosis is often overlooked because its symptoms overlap lung diseases and pulmonary arterial hypertension. Its diagnosis may be difficult because the condition is progressive and associated with other defects. We present a case of pulmonary vein stenosis in a newborn with stenosis of the left-sided common pulmonary vein, diffuse hypoplasia of the superior right pulmonary vein, and atresia of the inferior right pulmonary vein. Nathalie Jeanne Magioli Bravo-valenzuela, Guilherme Ricardo Nunes Silva, and Marcela Pinto Varella Copyright © 2015 Nathalie Jeanne Magioli Bravo-valenzuela et al. All rights reserved. Primary Cardiac Fibroma in an Adult Sun, 20 Sep 2015 07:26:07 +0000 Cardiac fibromas are benign primary tumors composed of connective tissue and fibroblasts. These uncommon tumors are primarily found in the pediatric population, and their prevalence among the adult population is exceedingly rare. We report a case of an adult with nonspecific symptoms, who was subsequently found to have a solitary mass located in the left ventricle. This case highlights an unusual finding in an adult who through various imaging modalities, surgical excision, and immunohistological analysis was found to have a cardiac fibroma. Samuel H. Cho, Timothy Fritz, Lynn J. Cronin, and Stephen D. Cohle Copyright © 2015 Samuel H. Cho et al. All rights reserved. A Case of Aortopulmonary Window: Asymptomatic until the First Pregnancy Thu, 17 Sep 2015 08:50:29 +0000 The aortopulmonary window (APW) is an abnormal communication between the ascending aorta and the pulmonary trunk in the presence of two separate semilunar valves. It is a rare congenital malformation which represents 0.1% of all congenital cardiac diseases. Herein, we report a very rare case of 27-year-old patient with unrepaired APW causing Eisenmenger syndrome and pulmonary hypertension who was asymptomatic until her first pregnancy. The median survival of uncorrected APW is 33 years. Aortopulmonary window is a very rare congenital anomaly. To our knowledge, asymptomatic adult case has not been reported until now. APW should be considered in the differential diagnosis of the severe pulmonary hypertension also in adult patients. Murat Kose, Serra Ucar, Samim Emet, Timur Selcuk Akpinar, and Kıvanc Yalin Copyright © 2015 Murat Kose et al. All rights reserved. Left Main Compression by a Giant Aneurysm of the Left Sinus of Valsalva: An Extremely Rare Reason for Myocardial Infarction and Cardiogenic Shock Tue, 15 Sep 2015 09:54:03 +0000 Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus. They might course with dyspnea, fatigue, and acute coronary syndromes. We present herein an extremely rare case report of a 61-year-old woman diagnosed with external left main coronary compression by a giant aneurysm of the left sinus of Valsalva, which was successfully managed with percutaneous coronary intervention. Bruno L. R. Faillace, Micheli Z. Galon, Marcos Danillo P. Oliveira, Guy F. A. Prado Jr., Adriano A. M. Truffa, Expedito E. Ribeiro, and Pedro A. Lemos Copyright © 2015 Bruno L. R. Faillace et al. All rights reserved. Left Ventricular Aneurysm Presenting as a Late Complication of Childhood Chemotherapy Thu, 10 Sep 2015 08:04:35 +0000 Cardiotoxicity is a well known adverse effect of chemotherapy. Multiple cardiac injuries have been reported including cardiomyopathy, pericarditis, myocarditis, angina, arrhythmias, and myocardial infarction. A left ventricular aneurysm due to chemotherapy is a rare and a dangerous complication which is particularly challenging in diagnosis requiring a high index of suspicion and periodic imaging. We present a case of a young Caucasian male with a past medical history of Acute Lymphocytic Leukemia status after chemotherapy during his childhood diagnosed with left ventricular aneurysm several years later. Braghadheeswar Thyagarajan, Lubna Bashir Munshi, and Martin Miguel Amor Copyright © 2015 Braghadheeswar Thyagarajan et al. All rights reserved. A Rare Case of Aortic Valve Thrombosis in Patient with Idiopathic Hypereosinophilic Syndrome Tue, 08 Sep 2015 09:21:26 +0000 Idiopathic hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia and eosinophil-mediated organ-system damage. Cardiac thrombosis and thromboembolic complications represent common causes of morbidity and mortality and usually involve cardiac ventricles or mitral and prosthetic valves, while the involvement of the aortic valve is extremely rare in HES. Here we report peculiar multimodality images of an atypical case of extended thrombosis of the aortic valve, complicated by myocardial ischemia and asymptomatic cerebral ischemia, likely due to thrombus embolization, occurring in a 48-year-old man with HES. Prompt anticoagulant and steroid therapy lead to rapid and complete resolution of the thrombotic lesions, allowing preserving the native valve and preventing further embolic events. Elisabetta Grolla, Michele Dalla Vestra, Luca Bonanni, Ada Cutolo, and Fausto Rigo Copyright © 2015 Elisabetta Grolla et al. All rights reserved. Culture Negative Stent Infection in an Infant with Hypoplastic Left Heart and Persistent Fever Tue, 08 Sep 2015 07:02:11 +0000 We present an infant with hypoplastic left heart with persistent fever despite two courses of antibiotics and repeatedly negative blood cultures. He eventually underwent surgical extraction of two stents. The stent cultures became positive; he was treated with 4 weeks of antibiotics and the fever resolved. Kurt D. Piggott, Federico Laham, Alejandro Jordan Villegas, Harun Fakioglu, Carlos Blanco, and Sukumar Suguna Narasimhulu Copyright © 2015 Kurt D. Piggott et al. All rights reserved. A Report of Accelerated Coronary Artery Disease Associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy Mon, 07 Sep 2015 05:50:52 +0000 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia and it is caused by mutations in the NOTCH3 gene. The neurologic manifestations of CADASIL syndrome have been well characterized; however, here we report one of the first de novo cases of CADASIL-associated coronary artery disease. A 45-year-old woman with a history of CADASIL and remote tobacco use presented with unstable angina. She was found to have diffuse and irregular narrowing of the left anterior descending artery and a drug eluting stent was deployed. Months later, she developed two subsequent episodes of unstable angina, requiring stent placement in the distal left anterior descending artery and the right coronary artery. Though the neurologic manifestations of CADASIL have been well described, these patients may also be predisposed to developing premature coronary artery disease. Patients with CADASIL and their physicians should be aware of this possible association because these patients may not be identified as high risk by traditional cardiovascular risk estimators. These patients may benefit from more aggressive interventions to reduce cardiac risk. Courtney B. Rubin, Virginia Hahn, Taisei Kobayashi, and Andrew Litwack Copyright © 2015 Courtney B. Rubin et al. All rights reserved. Constrictive Pericarditis: A Challenging Diagnosis in Paediatrics Sun, 06 Sep 2015 12:52:54 +0000 Constrictive pericarditis is an uncommon disease in children, usually difficult to diagnose. We present the case of a 14-year-old boy with a previous history of tuberculosis and right heart failure, in whom constrictive pericarditis was diagnosed. The case highlights the need to integrate all information, including clinical data, noninvasive cardiac imaging, and even invasive hemodynamic evaluation when required, in order to establish the correct diagnosis and proceed to surgical treatment. Mariana Faustino, Inês Carmo Mendes, and Rui Anjos Copyright © 2015 Mariana Faustino et al. All rights reserved. Isolated Right Ventricular Myocarditis: Rarely Reported Pathology Wed, 02 Sep 2015 14:07:23 +0000 Objective. Preventing the morbidity and mortality from isolated right ventricular myocarditis by its early recognition and treatment. Background. The clinical presentation of myocarditis ranges from nonspecific systemic symptoms (fever, myalgia, palpitations, or exertional dyspnea) to fulminant cardiac failure and sudden death. In our case, echocardiography raised the possibility of myocarditis at an early stage, although the signs and symptoms did not indicate right ventricular disease. Review of the literature showed only 4 previous reports, all diagnosed at autopsy, in which diagnosis was not suspected in vivo. Design/Methods. We are reporting case of a 23-year-old male with no past medical history who presented to emergency room with a nonexertional sharp left sided chest pain. Diagnostic tests were conducted, which revealed elevated troponins, decreased right ventricular ejection function but preserved left ventricular function, and no evidence of coronary artery disease. Results. A diagnosis of isolated right ventricular myocarditis was made on the basis of clinical, echocardiographic, and cardiac MRI findings. Conclusions. Isolated right ventricular myocarditis should be suspected in a patient with depressed right ventricular function without left ventricular involvement on echocardiography and cardiac MRI, elevated cardiac enzymes, and no evidence of coronary artery disease. Hafeez Ul Hassan Virk and Muhammad Bilal Munir Copyright © 2015 Hafeez Ul Hassan Virk and Muhammad Bilal Munir. All rights reserved. A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder Sun, 30 Aug 2015 13:53:24 +0000 We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting. Ronny Cohen, Alla Lysenko, Thierry Mallet, Brooks Mirrer, Michael Gale, Pablo Loarte, and Robert McCue Copyright © 2015 Ronny Cohen et al. All rights reserved. Respiratory Failure in an Adolescent with Primary Cardiac Sarcoma Wed, 19 Aug 2015 13:46:04 +0000 We report a case of progressive respiratory failure secondary to primary cardiac sarcoma masquerading as primary lung disease. An 18-year-old female presented to our hospital emergency department with progressive cough, dyspnea, and hemoptysis. She was treated for primary lung infection without improvement and had respiratory failure with endotracheal intubation by the third hospital day. An “intermediate” plasma brain natriuretic protein (BNP) of 216 pg/mL did not raise concerns about a heart failure diagnosis and may have delayed the correct diagnosis. Computed tomography of the chest with intravenous contrast was performed on the fifth hospital day and revealed a cardiac mass. A transthoracic echocardiogram confirmed a large left atrial mass that was obstructing mitral inflow. She was transferred to a tertiary center for emergency cardiac surgery. Primary cardiac tumors are a rare and treatable cause of heart failure in adolescent and young adult patients. Presentation can be confused with primary lung disease and must be suspected early. Plasma BNP cutoff levels used in the adult population should not be extrapolated to adolescents, as levels, both normal and abnormal, are significantly lower in this group of patients. Daniel Angeli and Stephen J. Angeli Copyright © 2015 Daniel Angeli and Stephen J. Angeli. All rights reserved. Mobile Intracardiac Mass after Inguinal Hernia Repair: An Unresolved Treatment Dilemma Sun, 16 Aug 2015 09:55:32 +0000 Right heart thrombi (RHT) are rare but well-described entity in literature. Their isolation has been considered as confirmatory for the diagnosis of venous thromboembolism (VTE). Even though their isolation aids the diagnosis, physicians are faced with a difficult management dilemma giving the paucity of data to support any treatment decision. We present a case of RHT in an 81-year-old man who presented to hospital with a large mobile right heart thrombus in transit seen on transthoracic echocardiogram (TTE). He was successfully treated with anticoagulation alone. This case highlights the importance of TTE in establishing the diagnosis and describes the interplay of factors influencing treatment decision. Fahad Almehmadi, Mark Davis, and Sheldon M. Singh Copyright © 2015 Fahad Almehmadi et al. All rights reserved. Rare Case of Rapidly Worsening REM Sleep Induced Bradycardia Sun, 16 Aug 2015 09:14:38 +0000 Sinoatrial arrest also known as sinus pause occurs when sinoatrial node of the heart transiently ceases to generate the electrical impulse necessary for the myocardium to contract. It may last from 2.0 seconds to several minutes. Etiologies of sinoatrial arrest can be complex and heterogeneous. During rapid eye movement (REM) sleep, sinus arrests unrelated to apnea or hypopnea are very rare and only a few cases have been reported. Here we report a case of 36-year-old male with no significant past medical history who presented to our hospital after a syncopal episode at night. Physical examination showed no cardiac or neurological abnormalities and initial EKG and neuroimaging were normal. Overnight telemonitor recorded several episodes of bradyarrhythmia with sinus arrest that progressively lengthened over time. Sleep study was done which confirmed that sinus arrests occurred more during REM sleep and are unrelated to apnea or hypopnea. Electrophysiology studies showed sinus nodal dysfunction with no junctional escape, subsequently a dual chamber pacemaker placed for rapidly worsening case of REM sleep induced bradycardia. Ayyappa S. Duba, Suneetha Jasty, Ankit Mahajan, Vijay Kodadhala, Raza Khan, Prithviraj Rai, and Mohammad Ghazvini Copyright © 2015 Ayyappa S. Duba et al. All rights reserved. Transapical Implantation of a 2nd-Generation JenaValve Device in Patient with Extremely High Surgical Risk Tue, 04 Aug 2015 11:44:38 +0000 Transcatheter Aortic Valve Replacement (TAVR) is performed in patients who are poor surgical candidates. Many patients have inadequate femoral access, and alternative access sites have been used such as the transapical approach discussed in this paper. We present an elderly and fragile patient not suitable for surgery for unacceptable high risk, including poor ventricular function, previous myocardial infarction with percutaneous coronary intervention, pericardial effusion, and previous cardiac surgery with replacement of mechanical mitral valve. Transapical aortic valve replacement with a second-generation self-expanding JenaValve is performed. The JenaValve is a second-generation transapical TAVR valve consisting of a porcine root valve mounted on a low-profile nitinol stent. The valve is fully retrievable and repositionable. We discuss transapical access, implantation technique, and feasibility of valve implantation in this extremely high surgical risk patient. Juan Mieres, Marcelo Menéndez, Carlos Fernández-Pereira, Miguel Rubio, and Alfredo E. Rodríguez Copyright © 2015 Juan Mieres et al. All rights reserved. Early Cardiac Tamponade in a Patient with Postsurgical Hypothyroidism Thu, 30 Jul 2015 11:30:23 +0000 Pericardial effusion is a common cardiac manifestation of hypothyroidism, but effusion resulting in cardiac tamponade is extremely rare. We present a case of a 56-year-old African American woman with slurred speech and altered mental status that was initially suspected to have stroke. Her chest X-ray revealed cardiomegaly and subsequent echocardiogram showed a large pericardial effusion with echocardiographic evidence of cardiac tamponade. Clinically, patient did not have pulsus paradoxus or hypotension. Further questioning revealed a history of total surgical thyroidectomy and noncompliance with thyroid replacement therapy. Pericardiocentesis was performed promptly and thyroxine replacement therapy was started. Thereafter, her mental status improved significantly. The management of pericardial effusion associated with hypothyroidism varies depending on size of effusion and hemodynamic stability of the patient. The management strategy ranges from conservative management with close monitoring and thyroxine replacement to pericardiocentesis or creation of a pericardial window. Archana Sinha, Sri Lakshmi Hyndavi Yeruva, Rajan Kumar, and Bryan H. Curry Copyright © 2015 Archana Sinha et al. All rights reserved. Biventricular Noncompaction Cardiomyopathy in an Adult with Unique Facial Dysmorphisms: Case Report and Brief Review Tue, 21 Jul 2015 12:24:02 +0000 Left ventricular noncompaction (LVNC) is a rare cardiomyopathy that is believed it to arise from an arrest in embryonic endomyocardial development. More recent studies suggest that it can be acquired later on in life sporadically. It may be accompanied by life-threatening complications, which are most commonly heart failure, arrhythmias, and thromboembolic events. We report a case of biventricular noncompaction cardiomyopathy in a 36-year-old man presenting for the first time with clinical heart failure as well as atrial arrhythmia. Transthoracic echocardiography (TTE) revealed LVNC with depressed ejection fraction (EF). Cardiac magnetic resonance imaging (MRI) further revealed a left atrial appendage thrombus as well as right ventricular noncompaction involvement. His physical exam was unique for a characteristic facial dysmorphisms pattern and developmental delays reminiscent of the earliest descriptions of LVNC in the pediatric population and it was rarely described in adult patients. This unique presentation underscores the importance of a better understanding of the genetics and natural course of LVNC. This will help us to elucidate the uncertainty surrounding its clinical management, discussed in a brief review of the literature following the case. Gaurav Rao and James Tauras Copyright © 2015 Gaurav Rao and James Tauras. All rights reserved. Mesalazine-Induced Myopericarditis in a Patient with a Recent Diagnosis of Crohn’s Disease: Apropos of a Case Tue, 21 Jul 2015 12:23:20 +0000 Mesalazine- (5-aminosalicylic acid-) containing products are a well-known treatment for inflammatory bowel disease, often as first line. Myocarditis is recognized as a very rare possible side effect of this drug treatment. We present a case of mesalazine-induced myopericarditis that was successfully improved by immediate cessation of the medication. Michele Sorleto, Stefanie Dürrwald, and Marcus Wiemer Copyright © 2015 Michele Sorleto et al. All rights reserved. Giant Cell Myocarditis: Not Always a Presentation of Cardiogenic Shock Thu, 16 Jul 2015 07:24:41 +0000 Giant cell myocarditis is a rare and often fatal disease. The most obvious presentation often described in the literature is one of rapid hemodynamic deterioration due to cardiogenic shock necessitating urgent consideration of mechanical circulatory support and heart transplantation. We present the case of a 60-year-old man whose initial presentation was consistent with myopericarditis but who went on to develop a rapid decline in left ventricular systolic function without overt hemodynamic compromise or dramatic symptomatology. Giant cell myocarditis was confirmed via endomyocardial biopsy. Combined immunosuppression with corticosteroids and calcineurin inhibitor resulted in resolution of symptoms and sustained recovery of left ventricular function one year later. Our case highlights that giant cell myocarditis does not always present with cardiogenic shock and should be considered in the evaluation of new onset cardiomyopathy of uncertain etiology as a timely diagnosis has distinct clinical implications on management and prognosis. Rose Tompkins, William J. Cole, Barry P. Rosenzweig, Leon Axel, Sripal Bangalore, and Anuradha Lala Copyright © 2015 Rose Tompkins et al. All rights reserved. Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature Wed, 15 Jul 2015 12:49:11 +0000 Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery. Mahesh Anantha Narayanan, Christopher DeZorzi, Abhilash Akinapelli, Toufik Mahfood Haddad, Aiman Smer, Janani Baskaran, and William P. Biddle Copyright © 2015 Mahesh Anantha Narayanan et al. All rights reserved. Severe Hyperthyroidism Presenting with Acute ST Segment Elevation Myocardial Infarction Tue, 14 Jul 2015 09:17:07 +0000 Introduction. Acute myocardial infarction is life-threatening. A cardiac troponin rise accompanied by typical symptoms, ST elevation or depression is diagnostic of acute myocardial infarction. Here, we report an unusual case of a female who was admitted with chest pain. However, she did not present with a typical profile of an acute myocardial infarction patient. Case Presentation. A 66-year-old Han nationality female presented with chest pain. The electrocardiogram (ECG) revealed arched ST segment elevations and troponin was elevated. However, the coronary angiography showed a normal coronary arterial system. Thyroid function tests showed that this patient had severe hyperthyroidism. Conclusion. Our case highlights the possibility that hyperthyroidism may cause a large area of myocardium injury and ECG ST segment elevation. We suggest routine thyroid function testing in patients with chest pain. Dayan Zhou, Zongjie Qu, Hao Wang, Zhe Wang, and Qiang Xu Copyright © 2015 Dayan Zhou et al. All rights reserved. Takotsubo Cardiomyopathy: A New Perspective in Asthma Sun, 12 Jul 2015 09:43:51 +0000 Takotsubo cardiomyopathy (TCM) is an entity of reversible cardiomyopathy known for its association with physical or emotional stress and may mimic myocardial infarction. We report an exceedingly rare case of albuterol-induced TCM with moderate asthma exacerbation. An interesting association that may help in understanding the etiology of TCM in the asthmatic population. Although the prognosis of TCM is excellent, it is crucial to recognize beta agonists as a potential stressor. Fady Y. Marmoush, Mohamad F. Barbour, Thomas E. Noonan, and Mazen O. Al-Qadi Copyright © 2015 Fady Y. Marmoush et al. All rights reserved. Superdominant Right Coronary Artery with Absence of Left Circumflex and Anomalous Origin of the Left Anterior Descending Coronary from the Right Sinus: An Unheard Coronary Anomaly Circulation Thu, 09 Jul 2015 08:27:55 +0000 Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. We present herein the case of a 70-year-old man with symptomatic severe aortic valvar stenosis whose preoperative coronary angiogram revealed a so far unreported coronary anomaly circulation pattern. Marcos Danillo Peixoto Oliveira, Fernando Roberto de Fazzio, José Mariani Junior, Carlos M. Campos, Luiz Junya Kajita, Expedito E. Ribeiro, and Pedro Alves Lemos Copyright © 2015 Marcos Danillo Peixoto Oliveira et al. All rights reserved. Ebstein’s Anomaly, Left Ventricular Noncompaction, and Sudden Cardiac Death Thu, 09 Jul 2015 08:04:09 +0000 Ebstein’s anomaly is a congenital disorder characterized by apical displacement of the septal leaflet of the tricuspid valve. Ebstein’s anomaly may be seen in association with other cardiac conditions, including patent foramen ovale, atrial septal defect, and left ventricular noncompaction (LVNC). LVNC is characterized by increased trabeculation within the left ventricular apex. Echocardiography is often used to diagnose LVNC; however, magnetic resonance (MR) imaging offers superior characterization of the myocardium. We report a case of sudden cardiac death in a patient with Ebstein’s anomaly with unrecognized LVNC noted on post mortem examination with screening documenting the presence of LVNC in one of the patient’s twin sons. Michael McGee, Luke Warner, and Nicholas Collins Copyright © 2015 Michael McGee et al. All rights reserved.