Case Reports in Cardiology The latest articles from Hindawi © 2020 , Hindawi Limited . All rights reserved. A Case of an Abdominal Aortic Dissection in a Hemodynamically Stable Marfan Syndrome Patient Presenting without Pain Tue, 25 Feb 2020 06:05:02 +0000 Introduction. Marfan syndrome (MFS) is a rare connective tissue disorder attributed to a defect in the fibrillin-1 gene. Aortic aneurysms and dissection are common causes of morbidity and mortality in Marfan syndrome. Case Report. A 43-year-old female with a history of MFS and a 4.0 cm dilated ascending aorta presented to her cardiologist reporting that since a C-section two years prior, the left side of her abdomen painlessly protruded when standing. An outpatient CT scan of the abdomen/pelvis noted a 5.5 cm abdominal aortic dissection, and she was directed to the hospital. Repeat CT scan of the abdomen/pelvis revealed a 5.6 cm dissecting aneurysm of the infrarenal abdominal aorta. The patient was admitted to the ICU and started on a nitroglycerin drip to maintain systolic blood pressure less than 110 mmHg. The patient underwent repair of her abdominal aortic dissection via a retroperitoneal approach, and she tolerated the procedure well. She was started on metoprolol tartrate 12.5 mg BID and aspirin 81 mg postoperatively. She was safely discharged with follow-up care. Conclusion. This case stresses the importance of having a low threshold to obtain imaging in a MFS patient with protruding abdomen, even though the patient may not have pain and be hemodynamically stable. Hussein Al-Mohamad, Kara Stout, Taryn Bolling, and Ronald Walsh Copyright © 2020 Hussein Al-Mohamad et al. All rights reserved. Acute Coronary Syndrome Mimicking Takotsubo Cardiomyopathy or Takotsubo Cardiomyopathy Mimicking Acute Coronary Syndrome? Mon, 24 Feb 2020 11:50:00 +0000 A healthy 66-year-old female presented to the emergency department with acute chest pain, T-wave inversion in the anterior leads, and elevated troponin-I. Coronary angiography showed a stenosis in the midportion of the left anterior descending coronary artery (LAD), which did not wrap the left ventricle (LV) apex. LV angiography demonstrated a large LV apical akinetic systolic ballooning with a 45% ejection fraction. Fractional flow reserve (FFR) of LAD lesion was 0.71. Percutaneous intervention was performed. At six months, transthoracic echocardiography was normal. Fifteen months later, the patient presented with chest pain and a small rise in troponin-I. Coronary angiogram was unchanged. Repeat FFR in distal LAD was 0.86 and left ventriculography was normal. Diagnostic criteria for Takotsubo cardiomyopathy (TTC) require the absence of obstructive coronary artery disease. In the present case, TTC was highly suspected on the basis of typical LV apex ballooning. However, significant ischemia in the same territory was demonstrated by positive FFR, which could not be falsely positive in this context. Current TTC diagnostic criteria increase specificity for diagnosing TTC. This case reminds us that it is at the price of reduced sensitivity, since there is no reason to believe that coronary lesions may protect from TTC. Chaumont Martin, Blaimont Marc, Briki Rachid, Unger Philippe, and Debbas Nadia Copyright © 2020 Chaumont Martin et al. All rights reserved. Master of the Masquerade: An Atypical Presentation of Acute Aortic Dissection Fri, 21 Feb 2020 06:35:01 +0000 Acute aortic dissection (AAD) is associated with unacceptably high mortality rate. As such, early diagnosis and aggressive management are essential in order to avoid life-threatening complications. Herein, we report an atypical presentation of AAD and clinical sequelae. Ramy Mando, Daniel Tim, Anthony DeCicco, Justin Trivax, and Ivan Hanson Copyright © 2020 Ramy Mando et al. All rights reserved. Left Bundle Branch Block Chest Pain Conundrum Thu, 20 Feb 2020 07:05:03 +0000 Left bundle branch block is a pattern of altered ventricular depolarization and subsequently affects repolarization. These obscure patterns can affect the traditional ST segment shift criteria for the electrocardiographic detection of coronary insufficiency syndromes. Previously, patients with coronary ischemic pain and LBBB judged to be “new” (not previously documented) were considered to have ST elevation myocardial infarction (STEMI) warranting acute thrombolytic therapy. Current STEMI management favors emergent invasive angiography; however, recent data suggests the prevalence of coronary obstructive pathology may be as low as 50%. The application of more specific, less-sensitive Sgarbossa electrocardiographic criteria may reduce angiographic assessment in an otherwise high-risk population unlikely to tolerate further myocardial injury. We present a case that may facilitate a more nuanced EKG-based approach to distinguish those who may benefit from acute invasive angiography while reducing the frequency of unnecessary angiographic evaluation. Karthik Seetharam, Ayesha Cheema, Gary Friedman, and Roman Pachulski Copyright © 2020 Karthik Seetharam et al. All rights reserved. Long-Term Outcome of Thrombolytic Therapy for Massive Pulmonary Embolism in Pregnancy Thu, 20 Feb 2020 07:05:02 +0000 A 25-year-old pregnant woman presented at 12 weeks of gestation with syncope and shortness of breath caused by massive pulmonary embolism. Due to persistent shock, fibrinolytic therapy with rtPA was administered. After fibrinolysis, clinical and hemodynamic response was excellent. No bleeding and fetal complications were recorded. Sy Van Hoang, Anh Tuan Vo, and Kha Minh Nguyen Copyright © 2020 Sy Van Hoang et al. All rights reserved. Plaque Rupture-Induced Myocardial Infarction and Mechanical Circulatory Support in Alpha-Gal Allergy Mon, 17 Feb 2020 23:05:00 +0000 Alpha-gal (AG) allergy is an IgE-mediated allergic reaction to galactose-alpha-1,3-galactose found in mammalian meat. Heparin, being derived from porcine intestinal tissue, may have a degree of cross-reactivity with AG antigen and thus place patients at risk for allergic and even anaphylactic reactions. This is especially important in patients with myocardial infarction (MI) and mechanical circulatory support, such as a left ventricular assist device (LVAD), since anticoagulation is immediately required. Therefore, individualized assessment and preoperative planning is needed regarding the use of heparin vs. nonheparinoid products in such a population. Sohab S. Radwan, Gauravpal Gill, Amre Ghazzal, Awais Malik, and Christopher Barnett Copyright © 2020 Sohab S. Radwan et al. All rights reserved. Wedged Sensor in Distress? Lessons Learned from Troubleshooting Dampened Transmitted PA Waveforms of CardioMEMS Device Tue, 11 Feb 2020 12:20:01 +0000 Introduction. Cardiovascular disease is a leading cause of morbidity and mortality with heart failure constituting a large portion of this spectrum. Heart failure patients have 90-day readmission rates of nearly 41% associated with a high expense. Numerous strategies to reduce readmissions have been attempted with the CardioMEMS pulmonary artery pressure monitoring system as one of the more successful ones. As this device becomes used more frequently, it is important to recognize procedural complications. We present of a rare complication where a patient underwent successful device placement and was subsequently found to have dampened waveforms which were due to device migration. Case Report. A 79-year-old male underwent successful CardioMEMS placement due to recurrent heart failure hospitalizations. 6 months later, the transmitted waveforms appeared dampened, and repeat angiography revealed a device that had migrated. Rather than abandoning the device, it was recalibrated and continued to transmit data and helped manage the patient’s heart failure. Conclusion. CardioMEMS is a cost-effective tool to help reduce heart failure hospitalizations. Device migration is a rare complication and can lead to inaccurate data. However, as seen in this case, the device can be successfully recalibrated and can continue to be utilized to help reduce heart failure admissions. Robby Singh, Santo Scarfone, and Marcel Zughaib Copyright © 2020 Robby Singh et al. All rights reserved. An Asymptomatic Patient with an Additional Cardiac Chamber Giant Left Atrial Appendage Fri, 07 Feb 2020 12:35:00 +0000 We present the case of an asymptomatic 54-year-old male, referred to our department for a follow-up cardiological consultation. Echocardiography assessment showed an unknown cavity adjacent to the lateral wall of the left ventricle. A large left atrial appendage was revealed in further investigations, and the treatment option was proved to be an impasse. Alexandros P. Evangeliou, Evangelia Sotiroglou, Nikolaos Charitakis, Georgios Loufopoulos, Christos Varassas, Spiridon Papadopoulos, Stergios Tzikas, and Vassilios Vassilikos Copyright © 2020 Alexandros P. Evangeliou et al. All rights reserved. Severe Prinzmetal’s Angina Inducing Ventricular Fibrillation Cardiac Arrest Fri, 07 Feb 2020 12:20:02 +0000 Prinzmetal’s angina is a vascular spasm of the coronary artery that can mimic acute coronary syndrome. It is rarely responsible for ventricular arrhythmias and cardiac arrest; however, survivors with these complications are at increased risk for recurrent ventricular arrhythmias and sudden cardiac death. This is true despite the presence of normal cardiac function and optimal medical therapy. Thus, this select population should be considered for an implantable cardioverter defibrillator (ICD). In this case vignette, we describe a healthy 48-year-old female with ventricular fibrillation arrest, followed by recurrent ventricular tachyarrhythmias caused by Prinzmetal’s angina. Bashar Khiatah, David Philips, Jonathan Dukes, and Amanda Frugoli Copyright © 2020 Bashar Khiatah et al. All rights reserved. Acute Coronary Syndrome after 17 Years of Bare Metal Stent Implantation: “Very” Very Late Stent Thrombosis Thu, 06 Feb 2020 08:20:00 +0000 Very late stent thrombosis (VLST) is a catastrophic and life-threatening complication after percutaneous coronary intervention which presents as an acute coronary syndrome with significantly high mortality and morbidity. VLST is a rare entity with drug-eluting stents and even rarer with bare metal stents. The exact pathophysiologic mechanism of VLST after BMS implantation is not known although various mechanisms have been proposed. Recently, in-stent neoatherosclerosis with intimal plaque rupture has been proposed as a potential mechanism of VLST after BMS. We report a rare case of VLST occurring 17 years after BMS implantation with angiographic and intravascular imaging evidence which provides insight into the mechanisms of VLST. Raghavendra Rao K, S. Reddy, J. R. Kashyap, K. Vikas, Hithesh Reddy, and Vadivelu Ramalingam Copyright © 2020 Raghavendra Rao K et al. All rights reserved. Primary Cardiac Lymphoma Manifesting as Complete Heart Block Wed, 05 Feb 2020 07:20:00 +0000 Primary cardiac tumors are exceedingly rare with variable clinical manifestations. This case involves a patient presentation of symptomatic complete heart block and cardiac imaging revealing a right atrial mass invading the myocardium consistent with Burkitt lymphoma on histopathology. The patient received definitive bradytherapy with a pacemaker and chemotherapy for the primary cardiac lymphoma. After three cycles of chemotherapy, the right atrial mass regressed significantly with restoration of atrioventricular conduction and no pacing burden. Primary cardiac lymphomas infrequently manifest as atrioventricular block and this case highlights cardiac masses as a potential etiology when evaluating new conduction disturbances and bradyarrhythmias. Courtney R. Usry, Andrew S. Wilson, and Kelvin N. V. Bush Copyright © 2020 Courtney R. Usry et al. All rights reserved. Pembrolizumab-Induced Mobitz Type 2 Second-Degree Atrioventricular Block Tue, 28 Jan 2020 12:50:00 +0000 Pembrolizumab is a monoclonal antibody directed towards programmed cell death protein 1 (PD-1) and is an antineoplastic drug which has a growing variety of oncologic uses. Pembrolizumab is commonly associated with immune-related adverse events (IRAEs) but is infrequently noted to cause cardiotoxicities such as myocarditis, arrhythmias, and heart failure. The following case report illustrates the clinical course of a 67-year-old female patient with stage IV non-small-cell lung cancer who developed Mobitz type 2 second-degree atrioventricular block three weeks after receiving her first infusion of pembrolizumab. Within a few hours of presentation, she progressed to symptomatic complete heart block requiring emergent placement of a temporary transvenous pacemaker. The article further discusses proposed mechanisms to explain IRAEs and management of IRAEs. We conclude by recommending a higher degree of caution and awareness among all physicians when treating patients on immunotherapy and a multidisciplinary approach when considering resumption of immune checkpoint inhibitor therapy. Alisha Khan, Sana Riaz, and Robert Carhart Jr. Copyright © 2020 Alisha Khan et al. All rights reserved. An Unusual Cause of Hypoxia: Ventricular Septal Defect, Pulmonary Artery Atresia, and Major Aortopulmonary Collaterals Diagnosed in the Adult Cardiac Catheterization Lab Mon, 27 Jan 2020 13:50:00 +0000 The association of pulmonary atresia, ventricular septal defect (VSD) and major aortopulmonary collaterals (MAPCA) is an extreme form of tetralogy of Fallot (TOF). It carries a high mortality risk if not intervened on during infancy with only 20% of unoperated patients surviving into adulthood. We present the case of a 40-year-old man who presented for evaluation prior to retinal surgery and was found to have hypoxia and a loud murmur. Cardiac catheterization was performed in the general catheterization laboratory, demonstrating a membranous VSD, pulmonary atresia, and MAPCA. We highlight the challenges and limitations that an adult interventional cardiologist may have when encountering these patients. Katia Bravo-Jaimes, Brian Walton, Poyee Tung, and Richard W. Smalling Copyright © 2020 Katia Bravo-Jaimes et al. All rights reserved. Case Report: TAVI in a Patient with Single Coronary Artery and Bicuspid Valve Sat, 25 Jan 2020 07:20:01 +0000 A single coronary artery is a rare congenital abnormality which consists of one coronary artery arising from the aortic trunk by a single coronary ostium and providing the perfusion of the entire myocardium. Its prevalence is approximately 0.024-0.066% of the population undergoing coronary angiography. A bicuspid aortic valve is the most common congenital cardiac abnormality and is found in 0.4-2.25% of the population. The coexistence of these two abnormalities together with severe aortic stenosis is extremely rarer. We report a patient who underwent transcatheter aortic valve implantation (TAVI) with a single coronary artery and a bicuspid valve. The procedure was successful, and the patient was discharged home without complication. To the best of our knowledge, this is the first report of these combined abnormalities and TAVI. Murielle Bertin, Mohamed Aboukofa, Pierre Francois Laterre, and Zuhair Yousif Copyright © 2020 Murielle Bertin et al. All rights reserved. Epicardial Unipolar Lead Loss of Ventricular Capture during Radiofrequency Ablation of Atrial Fibrillation Tue, 21 Jan 2020 15:20:00 +0000 Introduction. Abnormal pacemaker behavior can occur during radiofrequency ablation. The behaviors are varied and include loss of capture. The mechanisms in this context have not been well described in the literature. We describe a case of epicardial unipolar lead loss of ventricular capture during pulmonary vein isolation. Case History. A 48-year-old man with an epicardial dual chamber pacemaker and persistent atrial fibrillation presented for radiofrequency ablation (RFA) of his abnormal rhythm. During RFA, intermittent loss of ventricular capture was witnessed. Review of the device settings prior to and after the procedure showed an increase in ventricular threshold after the procedure. Loss of capture was shown to be dependent on location and RF energy delivered. It was independent of QTc and independent of local cellular changes that would increase threshold. Conclusion. We hypothesize the mechanism of loss of ventricular capture in this patient with an epicardial pacemaker with unipolar leads is related to intermittent shunt of voltage from the pulse generator to the grounding pad rather than the unipolar lead. Daniel J. Chu and Wilson W. Lam Copyright © 2020 Daniel J. Chu and Wilson W. Lam. All rights reserved. First Reported Case of Candida dubliniensis Endocarditis Related to Implantable Cardioverter-Defibrillator Fri, 17 Jan 2020 10:20:00 +0000 A 36-year-old male presented to the ED with acute chronic hyponatremia found on routine weekly lab work with one-week history of generalized weakness, confusion, nausea/vomiting, and diarrhea. The patient has nonischemic cardiomyopathy of unknown etiology diagnosed in his teens with an AICD device placed 8 years ago and receiving milrinone infusion 3 years ago via peripherally inserted central catheter (PICC) line. Two sets of blood cultures grew Candida dubliniensis. The patient was started on micafungin and the PICC line was removed and replaced with a central line. A transthoracic echocardiogram (TEE) showed findings consistent with AICD lead involvement. The patient was continued on treatment for fungal infective endocarditis and transferred to another hospital where he had successful AICD lead extraction. Blood cultures upon transfer back to our facility were positive for methicillin-sensitive Staphylococcus aureus (MSSA). This bacteremia was thought to be secondary to right-sided internal jugular (IJ) central line and resolved with line removal and initiation of intravenous (IV) cefazolin. The patient was discharged on IV cefazolin and IV micafungin. He had a LifeVest® until completion of his antibiotic course and a new AICD was placed. Nooraldin Merza, John Lung, Taryn B. Bainum, Assad Mohammedzein, Shanna James, Mazin Saadaldin, and Tarek Naguib Copyright © 2020 Nooraldin Merza et al. All rights reserved. Sclerotherapy Induced Takotsubo Syndrome Tue, 14 Jan 2020 14:50:00 +0000 A 66-year-old female was brought to the emergency department for acute-onset left-sided chest pain. Prior to arrival, she was at an outpatient appointment with a vascular surgeon for elective sclerotherapy treatment of her lower extremity varicose veins. After receiving an IV injection of polidocanol, she developed severe chest pain with left arm and jaw numbness for the first time in her life. Upon arrival to the ED, the patient reported that her symptoms had resolved. Electrocardiogram (ECG) on presentation was significant for T-wave inversions in leads V1-V3. An initial set of cardiac enzymes showed a troponin I level of 0.62 ng/mL, which subsequently increased to 2.26 ng/mL. Her echocardiogram was significant for mild left ventricular systolic dysfunction with apical hypokinesis (ejection fraction 50%). A repeat ECG showed new T-wave inversions compared to that from the time of admission. The patient eventually agreed to cardiac catheterization, which revealed patent vessels without coronary artery disease, supporting our diagnosis of Takotsubo syndrome and what is the first reported case of likely polidocanol-induced Takotsubo syndrome in the United States. Sunny Patel, Sepideh Nabatian, and Michael Goyfman Copyright © 2020 Sunny Patel et al. All rights reserved. A Rare Case of Multivessel SCAD Successfully Treated with Conservative Medical Management Sat, 11 Jan 2020 08:20:03 +0000 A female patient presented with severe, symptomatic multivessel spontaneous coronary artery dissection (SCAD) with no known medical history or risk factors. The affected vessels were left anterior descending artery (LAD), right coronary artery (RCA), and the ramus. She was treated with conservative medical management. Two months later, repeat coronary angiogram to evaluate for any residual disease was performed which showed near-complete resolution of all involved vessels. Lance Alquran, Ankita Patel, Lucy Safi, and Ankitkumar Patel Copyright © 2020 Lance Alquran et al. All rights reserved. Retrograde Balloon Dilation outside the Main Branch Stent to Restore the Occlusion of Side Branch in Chronic Total Occlusion Bifurcation Lesions Sat, 11 Jan 2020 08:20:02 +0000 Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) can be challenging when a bifurcation is present at the distal cap. We described a case of retrograde balloon outside the main branch stent to restore the occlusion of side branch in CTO bifurcation lesion through the jailed wire. Gao Hao-kao and Li Cheng-xiang Copyright © 2020 Gao Hao-kao and Li Cheng-xiang. All rights reserved. A Case of Acute Massive Bioprosthetic Mitral Valve Thrombosis Leading to Fulminant Heart Failure Sat, 11 Jan 2020 08:05:00 +0000 Bioprosthetic valve thrombosis has been considered to be extremely unlikely, typically freeing patients from the potential complications of long-term anticoagulation. However, there have been several documented cases of bioprosthetic valve thrombosis and there are concerns that its incidence may be underreported. Experience with diagnosis and management of this condition is limited. Here, we present a case of acute massive bioprosthetic mitral thrombosis manifesting as fulminant heart failure. Zeid Nesheiwat, Pinang Shastri, Rohit Vyas, Cameron Burmeister, Robert Grande, and Hazem Malas Copyright © 2020 Zeid Nesheiwat et al. All rights reserved. Monitored Anesthesia Care of Two Patients with Highly Elevated Subpulmonic Ventricular Pressure due to Adult Congenital Heart Disease Sat, 11 Jan 2020 07:20:00 +0000 Procedural sedation and analgesia for patients with adult congenital heart disease (ACHD) and highly elevated subpulmonic ventricular pressure require proper anesthesia care to prevent a pulmonary hypertensive crisis. We describe the monitored anesthesia care (MAC) of two patients with ACHD (a complete atrioventricular septal defect and congenitally corrected transposition of the great arteries) and highly elevated subpulmonic ventricular pressure. In both patients, preprocedural transthoracic echocardiography was useful for detecting severely elevated subpulmonic ventricular pressure. The MAC involved the infusion of propofol, dexmedetomidine, and fentanyl. Norepinephrine was continuously administered from the preanesthetic period. No hemodynamic instability or respiratory depression was observed during the MAC. Continuous administration of norepinephrine from the preinduction period was helpful for preventing hypotension. We added dexmedetomidine to our MAC regimen of propofol and fentanyl because it exerts both sedative and analgesic effects. Dexmedetomidine does not cause respiratory depression; thus, our MAC regimen is believed to be theoretically safe for patients with ACHD and elevated subpulmonic ventricular pressure. Our findings suggest that safe MAC for patients with ACHD and highly elevated subpulmonic ventricular pressure may require careful consideration of the anesthetic regimen and close observation by adequately trained personnel, which is best provided at regional ACHD centers. Tatsuya Kida, Tomoya Irie, and Takahisa Goto Copyright © 2020 Tatsuya Kida et al. All rights reserved. Subaortic Membrane Papillary Fibroelastoma Sat, 11 Jan 2020 06:35:00 +0000 A 61-year-old male presented for an annual exam and received a transthoracic echocardiogram (TTE) which revealed a mobile mass arising from a subaortic membrane. Further investigations with a transesophageal echocardiogram (TEE) and cardiac computerized tomography angiography (CTA) confirmed the presence of a mobile mass on a subaortic membrane. Cardiothoracic surgery was performed with an open operation removing the mass and subaortic membrane. Upon visual inspection, the mass was likened to a sea anemone and immunohistochemical staining performed pathologically confirmed the diagnosis of cardiac papillary fibroelastoma. This case represents the first reported example of a cardiac papillary fibroelastoma (PFE) arising from a subaortic membrane. Although PFEs are benign cardiac tumors, proper identification and consideration for excision of these lesions may be indicated to prevent thromboembolic complications. Robyn Bryde, Kevin Landolfo, Jordan C. Ray, Pragnesh Parikh, Qihui “Jim” Zhai, and Carolyn Landolfo Copyright © 2020 Robyn Bryde et al. All rights reserved. Incidental Anomalous Left Coronary Artery in a Transplanted Heart Fri, 27 Dec 2019 04:20:00 +0000 Anomalous coronary artery is an uncommon congenital cardiac anomaly that is often detected incidentally on coronary angiography. It has rarely been reported in the donor heart of patients who have undergone cardiac transplantation. Here, we report a case of a 72-year-old patient who received a second heart transplant and has been identified to have an anomalous left main coronary artery originating from the right coronary sinus on postoperative coronary angiography. Sri Harsha Patlolla, Saraschandra Vallabhajosyula, and Malcolm R. Bell Copyright © 2019 Sri Harsha Patlolla et al. All rights reserved. Suspected Brugada Phenocopy Secondary to Coronary Slow Flow Fri, 06 Dec 2019 12:50:01 +0000 Brugada syndrome (BrS) is a genetic condition that accentuates the risk of potentially lethal ventricular arrhythmias and sudden cardiac death (SCD) in a structurally normal heart. The Brugada electrocardiographic pattern may manifest separately from the syndrome—this clinical scenario has been described as Brugada phenocopy (BrP). Many etiologies of BrP have been reported, but it has not yet been reported as a result of coronary slow flow (CSF) phenomenon. This case report highlights a suspected coronary slow flow-associated Brugada type 1 electrocardiographic pattern, which subsequently normalized following the institution of guideline-directed medical therapy for acute coronary syndrome. Alicia Shim, Rajeev Seecheran, Valmiki Seecheran, Sangeeta Persad, Shiva Sreenivasan, Ronald Henry, and Naveen Anand Seecheran Copyright © 2019 Alicia Shim et al. All rights reserved. Cardiac Magnetic Resonance for Diagnosis of Neuroendocrine Tumor Metastases to the Right and Left Ventricles with Carcinoid Heart Disease Thu, 05 Dec 2019 14:35:00 +0000 A 76-year-old male with a small bowel neuroendocrine tumor with hepatic metastases presented with new onset lower extremity swelling, bloating, and weight gain which ultimately lead to cardiac magnetic resonance (CMR) to evaluate for cardiac involvement of disease. CMR showed right and left ventricular myocardial metastases along with findings suggestive of carcinoid heart disease. The patient had severe tricuspid valve regurgitation necessitating surgical valve repair. The patient underwent bioprosthetic tricuspid valve replacement and debulking of the metastases with surgical pathology confirming neuroendocrine tumor metastases. Follow-up clinical evaluations at 3, 6, and 9 months postoperatively showed improvement in cardiac function and stable hepatic tumor burden. This case demonstrates the utility of CMR to diagnose myocardial metastases and carcinoid heart disease complicated by severe tricuspid regurgitation, which guided surgical management. Daniel Barnebee, Brian Morse, Jonathan R. Strosberg, Marijan Pejic, and Daniel Jeong Copyright © 2019 Daniel Barnebee et al. All rights reserved. Hypertrophic Cardiomyopathy and Wolff-Parkinson-White Syndrome in a Young African Soldier with Recurrent Syncope Wed, 04 Dec 2019 12:50:03 +0000 Syncope is a common manifestation of both hypertrophic cardiomyopathy (HCM) and Wolff-Parkinson-White (WPW) syndrome. The most common arrhythmia in HCM is ventricular tachycardia (VT) and atrial fibrillation (AF). While preexcitation provides the substrate for reentry and supraventricular tachycardia (SVT), AF is more common in patients with preexcitation than the general population. Concurrence of HCM and WPW has been reported in many cases, but whether the prognosis or severity of arrhythmia is different compared to the individual disorders remains unsettled. We report a case of HCM and Wolff-Parkinson-White (WPW) syndrome in a 28-year-old male Nigerian soldier presenting with recurrent syncope and lichen planus. Mohammed Abdullahi Talle, Faruk Buba, Aimé Bonny, and Musa Mohammed Baba Copyright © 2019 Mohammed Abdullahi Talle et al. All rights reserved. The First Case of Native Mitral Valve Endocarditis due to Micrococcus luteus and Review of the Literature Wed, 04 Dec 2019 09:50:00 +0000 Gram-positive cocci species, notably Staphylococcus, Streptococcus, and Enterococcus account for 80 to 90% of infective endocarditis cases. HACEK microorganisms (Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) account for approximately 3% of cases and Candida species account for 1-2% of cases. Micrococcus luteus is a rare cause of endocarditis. To our knowledge, only 17 cases of prosthetic valve endocarditis have been described due to M. luteus and a single case of native aortic valve endocarditis has been described. The following case is the only documented case of native mitral valve endocarditis. A review of the literature pertaining to Micrococcus endocarditis was performed to further characterize the entity. Alisha Khan, Thu Thu Aung, and Debanik Chaudhuri Copyright © 2019 Alisha Khan et al. All rights reserved. A Case Report of Accidental Intoxication following Ingestion of Foxglove Confused with Borage: High Digoxinemia without Major Complications Fri, 29 Nov 2019 04:05:03 +0000 Foxglove (Digitalis purpurea L.) leaves are frequently confused with borage (Borago officinalis L.), which is traditionally used as a food ingredient. Due to the presence of the cardiac glycosides, mostly digitoxin, foxglove leaves are poisonous to human and may be fatal if ingested. A 55-year-old Caucasian woman complaining weakness, fatigue, nausea, and vomiting was admitted to the Emergency Department. Her symptoms started following consumption of a home-made savory pie with 5 leaves from a plant bought in a garden nursery as borage. Digoxinemia was high (10.4 μg/L). The patient was admitted to the cardiac intensive care unit for electrocardiographic monitoring. Two days after admission, a single episode of advanced atrioventricular (AV) block was recorded by telemetry, followed by a second-degree AV block episode. Plasma samples at day 11 were analysed by LC-MS spectrometry, and gitoxin was identified suggesting that this compound may be responsible for the clinical toxicity rather than digoxin. In the case of Digitalis spp. poisoning, laboratory data should be interpreted according to the clinical picture and method of analysis used since a variety of glycosides, which are chemically similar to the cardioactive glycosides but without or with fewer cardiac effects, may be incorrectly recognized as digoxin by the test, giving misleading results. Maria Silvia Negroni, Arianna Marengo, Donatella Caruso, Alessandro Tayar, Patrizia Rubiolo, Flavio Giavarini, Simone Persampieri, Enrico Sangiovanni, Franca Davanzo, Stefano Carugo, Maria Laura Colombo, and Mario Dell’Agli Copyright © 2019 Maria Silvia Negroni et al. All rights reserved. Spontaneous Coronary Artery Dissection in a Patient with a Family History of Fatal Ascending Aortic Dissection: Case Report and Discussion of Diseases Causing Both Presentations Mon, 25 Nov 2019 06:05:00 +0000 Background. Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Aortic dissection and SCAD share common aetiologies such as a fibromuscular dysplasia (FMD), Marfan, Ehlers Danlos, and more rarely systemic lupus erythematosus and Loeys-Dietz; however, SCAD has never been known to have a familial association with aortic dissection. Case Summary. This case report describes a 48-year-old woman suffering from SCAD who had a mother who died from ascending aortic dissection in her 50s. Discussion. This is the first case report to our knowledge of a patient with SCAD with a first-degree relative with aortic dissection. Our case is interesting in that it shows that if predisposition to arterial dissection was inherited from mother to daughter, one of them suffered an extremely rare manifestation of their underlying disease. It also shows that a high index of suspicion is needed for SCAD in the presence of a patient with ACS and a family history of dissection elsewhere in the arterial tree. George Joy and Hany Eissa Copyright © 2019 George Joy and Hany Eissa. All rights reserved. Corrigendum to “Pulmonary Hypertension Secondary to Partial Anomalous Pulmonary Venous Return in an Elderly Patient” Thu, 21 Nov 2019 12:05:02 +0000 Stefan Koester, Justin Z. Lee, and Kwan S. Lee Copyright © 2019 Stefan Koester et al. All rights reserved.