Case Reports in Cardiology https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Cryoablation for Ventricular Tachycardia Originating from Anterior Papillary Muscle of Left Ventricle Guided by Intracardiac Echocardiography Thu, 20 Apr 2017 06:59:36 +0000 http://www.hindawi.com/journals/cric/2017/9734795/ Papillary muscles (PMs) were reported to be origin of ventricular arrhythmia (VA). Radiofrequency (RF) ablation was reported to be acutely effective in eliminating VA. However, the recurrence rate is high. Recently, cryoablation guided by intracardiac echocardiography, 3-dimensional mapping system, and image integration was introduced as alternative strategy for this challenging ablation. We present a case of ventricular tachycardia originating from anterior PM of left ventricle treated by cryoablation guided only by intracardiac echocardiography. Ibrahim Marai, Nizar Andria, and Osnat Gurevitz Copyright © 2017 Ibrahim Marai et al. All rights reserved. Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach Sun, 16 Apr 2017 08:24:47 +0000 http://www.hindawi.com/journals/cric/2017/8510160/ This case report concerns a young woman who, during her pregnancy, suffered severe mitral regurgitation. It was discovered at the same time that she had a left atrial myxoma. During the early postpartum period she successfully underwent an anterior minithoracotomy to remove the left atrial myxoma in conjunction with repair of the mitral valve. The thoracotomy approach in this specific patient was chosen as it would give a better chance of successful mother-child bonding because the patient would be able to avoid the precautions which would have been necessary following a sternotomy, especially the limitation of her ability to hold her child during the first 4–6 weeks postoperatively. Noppon Taksaudom, Kuntharee Traisrisilp, and Rungsrit Kanjanavanit Copyright © 2017 Noppon Taksaudom et al. All rights reserved. Retrieval of Embolized Amplatzer Patent Foramen Ovale Occlusion Device: Issues Related to Late Recognition Sun, 16 Apr 2017 08:12:31 +0000 http://www.hindawi.com/journals/cric/2017/9894215/ Embolization of a percutaneous patent foramen ovale (PFO) closure device is a rare but serious complication. While early, periprocedural device embolization can normally be managed with snare and percutaneous retrieval, late embolization requires a different management strategy due to inability of the device to deform to allow passage into a large caliber sheath. We present a case of asymptomatic device embolization recognized six months following implantation and discuss the challenges encountered in successfully retrieving the device. Allan J. Davies, Nicholas Collins, and Nicole Organ Copyright © 2017 Allan J. Davies et al. All rights reserved. Absence of Left Circumflex Artery: A Rare Congenital Disorder of Coronary Arteries Sun, 16 Apr 2017 07:50:50 +0000 http://www.hindawi.com/journals/cric/2017/8710135/ Congenital absence of left circumflex artery is a rare occurrence and very few cases have been reported in literature. It is a benign incidental finding; however some patients present with sudden onset chest pain mimicking acute coronary syndrome often resulting in detection of this rare anatomy on coronary angiography. Coronary computed tomography angiography is a relatively new noninvasive imaging modality which can be used to confirm this suspicion and diagnose this unique morphology reliably. Saad Ullah, Muzammil Khan, Noman Ahmed Jang Khan, Hassan Zeb, and Roshan Patel Copyright © 2017 Saad Ullah et al. All rights reserved. Severe Dilatation of Coronary Artery Ostium Complicating Sinus of Valsalva Aneurysm: Differential Diagnosis and Review of the Literature Thu, 13 Apr 2017 10:13:49 +0000 http://www.hindawi.com/journals/cric/2017/8694652/ Coronary artery dilatation may be due to various aetiologies including congenital anomalies, atherosclerotic coronary disease, and Kawasakis disease. We describe a case characterised by apparent severe dilatation of the right coronary artery ostium in an asymptomatic male. Subsequent imaging and surgical intervention documented the presence of a sinus of Valsalva aneurysm extending into the ostium of the right coronary artery. This represents an unusual manifestation of a sinus of Valsalva aneurysm. The underlying pathophysiology, differential diagnosis, role of surgical management, and outcomes are discussed. Paul Bamford and Nicholas Collins Copyright © 2017 Paul Bamford and Nicholas Collins. All rights reserved. Reversible Myocardial Injury and Intraventricular Thrombus Associated with Aluminium Phosphide Poisoning Sun, 09 Apr 2017 10:45:14 +0000 http://www.hindawi.com/journals/cric/2017/6287015/ Aluminium phosphide (ALP) is widely used as a fumigant pesticide. In case of ALP poisoning, it is responsible for myocardial dysfunction, related to toxic myocarditis, and hemodynamic disorders. We report a case of a 28-year-old female who had intentionally ingested ALP and was admitted with cardiogenic shock. The transthoracic echocardiography (TTE) at the time of admission showed severe global myocardial hypokinesia with the presence of a giant left ventricular thrombus. Cardiovascular magnetic resonance (CMR) revealed extensive toxic myocarditis with a left ventricular systolic dysfunction. All cardiac lesions were reversible after symptomatic treatment, within 6 months. We aim, by reporting this case, to evidence the complete reversibility of cardiac injury due to aluminium phosphide poisoning documented by transthoracic echocardiography and cardiovascular magnetic resonance. Abdelkader Jalil El Hangouche, Hala Fennich, Oumaima Alaika, Taoufiq Dakka, Zaineb Raissouni, Latifa Oukerraj, Nawal Doghmi, and Mohamed Cherti Copyright © 2017 Abdelkader Jalil El Hangouche et al. All rights reserved. Surgical Repair of Subacute Right Ventricular Perforation after Pacemaker Implantation Thu, 06 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/3242891/ We report an 84-year-old woman who presented with right ventricular perforation 4 days after pacemaker implantation for syncope due to sick sinus syndrome. Median sternotomy revealed no pericardial effusion, but the pacing lead had penetrated the right ventricle and pericardium. When the pleura was opened, the tip of the lead was seen in the visceral pleura. The lead was cut in the pericardial cavity and extracted from the left subclavian wound together with the generator. The right ventricular perforation was sutured and a temporary pacing lead was placed on the right ventricular wall intraoperatively. Ten days after the surgery, a new pacemaker lead was placed in the ventricular septum via the right axillary vein. Right ventricular perforation is a rare complication after pacemaker implantation. Typically, it occurs at the time of implantation or within 24 hours after implantation. In the present case, the perforation of the right ventricle which needed urgent surgery occurred 4 days after implanting the pacing lead at the right ventricular apex. Great care should have been taken not to overlook this life-threatening complication even more than 24 hours after pacemaker implantation. Takeshi Oda, Takanori Kono, Keiichi Akaiwa, Yasushi Takahara, Chie Yasuoka, and Katsuhiko Nakamura Copyright © 2017 Takeshi Oda et al. All rights reserved. Life-Threatening Hemopericardium Associated with Rivaroxaban Wed, 05 Apr 2017 07:32:09 +0000 http://www.hindawi.com/journals/cric/2017/4691325/ Rivaroxaban is a novel oral anticoagulant used in the treatment of venous thromboembolism. The use of this medication has expanded over the recent years with resultant expansion of side effect profile. We present a case of a 56-year-old female who presented with shortness of breath and chest pain 12 weeks after starting rivaroxaban for left upper extremity deep vein thrombosis. She was later diagnosed with spontaneous hemopericardium requiring pericardial fluid drainage. Rarer side effects like this will be encountered more often with the increasing use of novel oral anticoagulants. The clinicians should be cognizant of this entity among patients with shortness of breath and chest pain for timely diagnosis and intervention. Sijan Basnet, Niranjan Tachamo, Biswaraj Tharu, Rashmi Dhital, Sushil Ghimire, and Dilli Ram Poudel Copyright © 2017 Sijan Basnet et al. All rights reserved. Peeled Guidewire Coating with Debulked Plaque Obtained by Directional Coronary Atherectomy Wed, 05 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/2397183/ Percutaneous directional coronary atherectomy (DCA) is a plaque debulking method performed in Japan, and recently a renewed DCA device has been launched. We present a case with a tight left anterior descending lesion undergoing percutaneous coronary intervention with application of DCA. After several sessions of DCA, white plaques accompanied by green, stringed materials were obtained from the device; some materials were considerably long (approximately 15 mm in length). A drug-eluting stent was subsequently implanted, and the procedure was completed successfully without any complications. The extracted plaques and artificial materials were pathologically examined, and no inflammatory changes were detected on plaques adjacent to the material. Assessing pathological findings and structure of the DCA catheter, the obtained artificial materials were considered as peeled guidewire, possibly resulting from the friction between the guidewire and metallic bearing in the housing of DCA catheter. Of note, this phenomenon has been recognized even in other DCA cases in which guidewires of the other kind are used. We report this phenomenon for the first time, warning of theoretically possible distal embolization of artificial materials caused by any debulking devices. Rikuta Hamaya, Taishi Yonetsu, Sadamitsu Ichijo, Makoto Araki, Tadashi Murai, Yoshihisa Kanaji, Eisuke Usui, Junji Matsuda, Masahiro Hoshino, Masahiro Hada, Takayuki Niida, Yoshinori Kanno, and Tsunekazu Kakuta Copyright © 2017 Rikuta Hamaya et al. All rights reserved. Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome Sun, 02 Apr 2017 08:04:56 +0000 http://www.hindawi.com/journals/cric/2017/9092576/ Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4–18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. A 79-year-old woman, with a history of recent total hysterectomy with adnexectomy and a Wells procedure, presented to the emergency department following an episode of syncope. Computed tomography revealed bilateral PE and the presence of a right atrial thrombus. Transthoracic echocardiography demonstrated a free-floating type A thrombus in the right atrium, protruding into the right ventricle, and signs of pulmonary hypertension and right ventricle dysfunction. Considering the recent surgery and clinical stability, treatment with heparin alone was decided. Subsequent clinical improvement was observed and echocardiographic follow-up revealed complete thrombus dissolution and complete recovery of right ventricle function. Most authors recommend treatment of PE with RHT with thrombolysis or embolectomy followed by anticoagulation, although evidence is scarce. Individual risk of hemorrhage and operatory-related mortality should be taken into account when defining the treatment strategy especially when benefit is not firmly established. João Português, Lucy Calvo, Margarida Oliveira, Vítor Hugo Pereira, Joana Guardado, Mário Rui Lourenço, Olga Azevedo, Francisco Ferreira, Filipa Canário-Almeida, and António Lourenço Copyright © 2017 João Português et al. All rights reserved. Papillary Fibroelastoma as a Cause of Cardiogenic Embolic Stroke in a β-Thalassemia Patient: Case Report and Literature Review Sun, 26 Mar 2017 07:40:39 +0000 http://www.hindawi.com/journals/cric/2017/8185601/ We describe a case of a young male without stroke risk factors who presented with a sudden onset of left-sided weakness, left hand numbness, and left eye blurriness. CT scan of the head without contrast and diffusion-weighted MRI of the brain with contrast revealed an ischemic stroke in the right middle cerebral artery distribution. Transesophageal echocardiography (TEE) revealed a mobile pedunculated mass on the posterior surface of the mitral valve. This mass was resected and pathology showed a cardiac papillary fibroelastoma (CPFE), which was determined to be the cause of the patient’s cardioembolic stroke. Further workup also found that patient had microcytic anemia secondary to β-thalassemia intermedia, a rare hematologic disorder due to defective hemoglobin synthesis. Recently, another case report suggested β-thalassemia major may underlie the pathogenesis of CPFE. β-Thalassemia major causes a state of chronic inflammation and endothelial damage, which can mediate CPFE formation. Based on literature review, this is the first case report of a CPFE in a patient with β-thalassemia intermedia. This hypothesis-generating case report calls attention to the need for elucidating the relationship between CPFE and β-thalassemia in future studies to better understand the diagnosis and management of a rare cardiac tumor. Re-I Chin, John J. Monda, Maulik Sheth, William Ogle, Gloria Merenda, and Debapriya De Copyright © 2017 Re-I Chin et al. All rights reserved. Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm Sun, 19 Mar 2017 10:19:32 +0000 http://www.hindawi.com/journals/cric/2017/7875240/ Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV) in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred. Sorin Giusca, Tom Eisele, Peter Nunninger, Benedikt Münz, and Grigorios Korosoglou Copyright © 2017 Sorin Giusca et al. All rights reserved. Adult Onset Dysphagia: Right Sided Aortic Arch, Ductus Diverticulum, and Retroesophageal Ligamentum Arteriosum Comprising an Obstructing Vascular Ring Wed, 15 Mar 2017 07:06:31 +0000 http://www.hindawi.com/journals/cric/2017/9614835/ A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of the ductus diverticulum and division of the retroesophageal ligamentum arteriosum led to complete resolution of our patient’s symptoms. Ankur Sinha, Hitesh Raheja, Vinod Namana, Sunil Abrol, Stephan Kamholz, and Vijay Shetty Copyright © 2017 Ankur Sinha et al. All rights reserved. Ventricular Septal Dissection Complicating Inferior Wall Myocardial Infarction Wed, 15 Mar 2017 06:59:54 +0000 http://www.hindawi.com/journals/cric/2017/9680891/ Postmyocardial infarction ventricular septal defect is an increasingly rare mechanical complication of acute myocardial infarction. We present a case of acute myocardial infarction from right coronary artery occlusion that developed hypotension and systolic murmur 12 hours after successful percutaneous coronary intervention. Although preoperative imaging suggested a large ventricular septal defect and a pseudoaneurysm, intraoperative findings concluded a serpiginous dissection of the ventricular septum. The imaging technicalities are discussed. Lindsey Kalvin, Rayan Yousefzai, Bijoy K. Khandheria, Timothy E. Paterick, and Khawaja Afzal Ammar Copyright © 2017 Lindsey Kalvin et al. All rights reserved. Takotsubo Cardiomyopathy in a Patient with Undiscovered Sigmoid Colon Cancer Thu, 09 Mar 2017 09:03:27 +0000 http://www.hindawi.com/journals/cric/2017/4563203/ Takotsubo cardiomyopathy (TTC) is a stress-related cardiomyopathy that is characterized by reversible left systolic dysfunction, which appears to be precipitated by sudden emotional or physical stress in the absence of myocardial infarction. Here we present a rare case that clinically presented with intermittent abdominal pain, initially impressed as non-ST elevation myocardial infarction and congestive heart failure but with a normal coronary angiogram. Her symptoms relieved spontaneously without returning. Sigmoid colon cancer was diagnosed via colonoscopy later due to persistent abdominal discomfort. In the absence of detectable emotional or physical stress factors, the newly diagnosed sigmoid colon cancer was the only possible trigger factor of TTC. We offer this case as a reminder that cancer should be considered in the differential diagnosis of patients presenting with the etiology of TTC. Huang Po-Yen and Ku Po-Ming Copyright © 2017 Huang Po-Yen and Ku Po-Ming. All rights reserved. Premature Ventricular Complex Causing Ice-Pick Headache Tue, 07 Mar 2017 08:16:10 +0000 http://www.hindawi.com/journals/cric/2017/3879127/ Ice pick headache is a momentary, transient, repetitive headache disorder and manifests with the stabbing pains and jolts. The exact mechanism causing this disease is unknown. Premature ventricular contractions are early depolarization of the ventricular myocardium and in the absence of a structural heart disease, it is considered to be a benign disease. In this report, we describe a male patient presenting with the symptom of momentary headache attacks accompanied with instant chest pain which is associated with premature ventricular contraction. Selcuk Ozturk and Ertan Yetkin Copyright © 2017 Selcuk Ozturk and Ertan Yetkin. All rights reserved. FOLFOX Induced Takotsubo Cardiomyopathy Treated with Impella Assist Device Tue, 07 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/8507096/ Chemotherapy induced cardiotoxicity is becoming increasingly prevalent with several new agents being used recently. The incidence of Takotsubo cardiomyopathy due to 5-fluorouracil based chemotherapeutic regimens like FOLFOX is not uncommon. It is also seen with platinum based chemotherapy. Most of these patients have reversible cardiotoxicity and the cardiac function recovers within a short period with supportive treatment. Here we have a patient who presented with cardiogenic shock after 5 days of receiving FOLFOX regimen for colorectal adenocarcinoma. She was treated with a percutaneous left ventricular assist device, Impella CP, for hemodynamic support with excellent outcome. Swethika Sundaravel, Abdulah Alrifai, Mohamad Kabach, and Waqas Ghumman Copyright © 2017 Swethika Sundaravel et al. All rights reserved. Transcatheter Aortic Valve Implantation in an Extremely Tortuous S-Shaped Aorta Thu, 02 Mar 2017 09:10:29 +0000 http://www.hindawi.com/journals/cric/2017/2936513/ Transcatheter aortic valve implantation (TAVI) has emerged as an alternative technique to treating aortic stenosis in patients with high surgical risk. We present a case of a successful transfemoral TAVI in a high-risk patient with an extremely tortuous iliofemoral system and a significant S-type bend in the descending aorta. With careful preprocedure planning and using all the techniques available, TAVI can be performed in the most challenging patients. Shuangbo Liu, Olga Toleva, Amir Ravandi, Zlatko Pozeg, Alan Menkis, and Malek Kass Copyright © 2017 Shuangbo Liu et al. All rights reserved. Conventional Coronary Angiography Induced Takotsubo Cardiomyopathy Complicated with Cardiac Tamponade Wed, 01 Mar 2017 07:23:35 +0000 http://www.hindawi.com/journals/cric/2017/5631264/ Takotsubo cardiomyopathy (TCM) is a transient left ventricular dysfunction that typically occurs after emotional or physical stress. TCM has a benign prognosis and serious complications are uncommon. However, though very rarely reported, cardiac tamponade has occurred on some occasions. We hereby report the case of a 70-year-old woman who underwent coronary angiography with an ergonovine provocation test to evaluate recurrent chest pain and was readmitted 7 days later presenting with TCM, followed by left ventricular outflow tract obstruction and cardiac tamponade. Min Gyu Kang, Kye-Hwan Kim, Jin-Sin Koh, Young-Hoon Jeong, Jin-Yong Hwang, and Jeong Rang Park Copyright © 2017 Min Gyu Kang et al. All rights reserved. ACE Inhibitor-Induced Angioedema following Cervical Spine Surgery Tue, 28 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/4268962/ Angioedema is a well-known side effect of angiotensin converting enzyme inhibitors (ACEi). However, ACE inhibitors induced angioedema after cervical surgery is a rare condition. They result in increased levels of circulating bradykinins. Rare cases of angioedema following local trauma in patients using ACE inhibitors have been published. We present such a case. A 54-year-old Caucasian female with a history significant for hypertension, controlled with lisinopril, was admitted for routine cervical spine surgery. She has severe degenerative cervical disc disease and was admitted to the hospital for an elective cervical diskectomy. The patient failed weaning off the ventilator on multiple attempts postoperatively. There were no observed symptoms of an allergic reaction. A CT scan of the neck showed extensive soft tissue edema at the level of the arytenoids. Dexamethasone was given to reduce the edema without successful resolution. On review of her medications, it was found that the patient was resumed on lisinopril following the procedure. It was subsequently discontinued. By the following day the patient had a positive leak around the ET tube cuff and patient was successfully extubated. Faris Hannoodi and Hussam Sabbagh Copyright © 2017 Faris Hannoodi and Hussam Sabbagh. All rights reserved. Myocardial Infarction after Endoscopic Removal of Foreign Body Sun, 26 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/4541587/ The development of cardiac complications during or after endoscopic procedures is rare. However, mortality from myocardial ischemia, particularly in the elderly population, is elevated. We illustrate the rare case of a 79-year-old man with multiple cardiovascular risk factors who developed a non-ST elevation myocardial infarction (NSTEMI) after endoscopic removal of a foreign body. This case report summarizes a rare complication of a low-risk procedure and highlights the importance of considering this potential adverse event, particularly in patients with significant cardiovascular risk factors, to promote early diagnosis and proper treatment. Carola Maraboto, Florentino Lupercio, and Ileana L. Piña Copyright © 2017 Carola Maraboto et al. All rights reserved. Hyperkalemia Induced Brugada Phenocopy: A Rare ECG Manifestation Thu, 23 Feb 2017 10:02:13 +0000 http://www.hindawi.com/journals/cric/2017/9464728/ Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar ECG findings predisposing individuals to ventricular arrhythmias, syncope, and sudden cardiac death (SCD). Various electrolyte disturbances and ion channels blocking drugs could also provoke BrS ECG findings without genetic BrS. Clinical differentiation and recognition are essential for guiding the legitimate action. Hyperkalemia is well known to cause a wide variety of ECG manifestations. Severe hyperkalemia can even cause life threatening ventricular arrhythmias and cardiac conduction abnormalities. Most common ECG findings include peaked tall T waves with short PR interval and wide QRS complex. Since it is very commonly encountered disorder, physicians need to be aware of even its rare ECG manifestations, which include ST segment elevation and Brugada pattern ECG (BrP). We are adding a case to the limited literature about hyperkalemia induced reversible Brugada pattern ECG changes. Muhammad Ameen, Ghulam Akbar, Naeem Abbas, and Ghazi Mirrani Copyright © 2017 Muhammad Ameen et al. All rights reserved. Singleton Merten Syndrome: A Rare Cause of Early Onset Aortic Stenosis Tue, 21 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/8197954/ Singleton Merten syndrome (SMS) is a rare autosomal dominant genetic disorder with variable expression. Its characteristic features include abnormal aortic calcification, abnormal ossification of extremities, and dental anomalies. We present a young man with dyspnea who was noted to have aortic stenosis in the background of glaucoma, psoriasis, dental anomalies, hand and foot deformities, Achilles tendinitis, osteopenia, and nephrolithiasis. The conglomeration of features led to the diagnosis of SMS. His mother had a very similar phenotype. Harshavardhan Ghadiam and Sudhir Mungee Copyright © 2017 Harshavardhan Ghadiam and Sudhir Mungee. All rights reserved. Right Ventricular Compression Mimicking Brugada-Like Electrocardiogram in a Patient with Recurrent Pectus Excavatum Mon, 20 Feb 2017 08:46:37 +0000 http://www.hindawi.com/journals/cric/2017/3047937/ Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS). Jinhee Ahn, Jong-Il Choi, Jaemin Shim, Sung Ho Lee, and Young-Hoon Kim Copyright © 2017 Jinhee Ahn et al. All rights reserved. Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient Mon, 20 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/7134586/ Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired. Sylvia Biso, Rapeepat Lekkham, and Antoinette Climaco Copyright © 2017 Sylvia Biso et al. All rights reserved. Augmenting Function for Infarction from Infection: Impella 2.5 for Ischemic Cardiogenic Shock Complicating Sepsis Sun, 05 Feb 2017 10:44:46 +0000 http://www.hindawi.com/journals/cric/2017/8407530/ Cardiac dysfunction is a common complication of sepsis in individuals with preexisting coronary disease and portends a poor prognosis when progressing to ischemic cardiogenic shock. In this setting, maximal medical therapy in isolation is often inadequate to maintain cardiac output for patients who are poor candidates for immediate revascularization. Furthermore, the use of vasopressors and inotropes increases myocardial demand and may lead to further injury. Percutaneous ventricular assist devices provide a viable option for management of severe shock with multiorgan failure. The Impella is one of several novel mechanical support systems that can effectively augment cardiac output while reducing myocardial demand and serve as a bridge to recovery from severe hemodynamic compromise. This case report describes the successful utilization of the Impella 2.5 in a patient with baseline profound anemia and coronary artery disease (CAD) presenting in combined distributive and cardiogenic shock associated with a type 2 myocardial infarction complicating sepsis. Praveen George, Mukta C. Srivastava, Jonathan Ludmir, Robert M. Reed, Semhar Z. Tewelde, Anuj Gupta, and Michael T. McCurdy Copyright © 2017 Praveen George et al. All rights reserved. Type 1 Kounis Syndrome in Patient with Idiopathic Anaphylaxis Tue, 31 Jan 2017 09:05:23 +0000 http://www.hindawi.com/journals/cric/2017/1089023/ Kounis syndrome represents the concurrence of acute coronary syndromes or anginal pain with allergic, hypersensitivity, and anaphylactic reactions. It can be associated with normal coronary angiogram or preexistent coronary pathology. Idiopathic anaphylaxis is defined as anaphylaxis without any identifiable precipitating agent or event. We present a case of male who experienced attacks of dyspnoea, hypoxemia, hypotension, purple-red skin, and chest pain over several years. He was diagnosed with idiopathic anaphylaxis. Based on the pattern of chest pain of ischemic origin during the attacks he was retrospectively diagnosed with Kounis syndrome. Tajda Keber, Jana Makuc, and Gregor Sekavčnik Copyright © 2017 Tajda Keber et al. All rights reserved. Ticagrelor Associated Heart Block: The Need for Close and Continued Monitoring Thu, 26 Jan 2017 11:10:29 +0000 http://www.hindawi.com/journals/cric/2017/5074891/ Ticagrelor is an antiplatelet agent prescribed to prevent the development of adverse cardiac events after acute coronary syndrome (ACS). According to the PLATO trial, ticagrelor is associated with ventricular pauses in the first week of treatment; however, these episodes were felt to be asymptomatic and nonfatal to the patient. We present a case of ticagrelor related second-degree type II heart block causing severe dizziness and diaphoresis that resolved after discontinuation of the medication. Munish Sharma and Daniel A. N. Mascarenhas Copyright © 2017 Munish Sharma and Daniel A. N. Mascarenhas. All rights reserved. Saddle Pulmonary Embolism with Thrombus in Transit across a Patent Foramen Ovale Thu, 26 Jan 2017 08:04:09 +0000 http://www.hindawi.com/journals/cric/2017/6752709/ This is the case of a 25-year-old obese man who presented with acute shortness of breath, chest pain, and palpitations. Of note, he lives a sedentary lifestyle and was recently hospitalized for incision and drainage of a left foot abscess. On presentation he was tachypnoeic, tachycardiac, and hypoxic but blood pressure was stable. Laboratory studies were significant for elevated D-dimer and mildly increased troponin. On further investigation he was found to have a saddle pulmonary embolism with massive clot burden. Echocardiogram revealed thrombus in transit and McConnell’s sign. He underwent surgical embolectomy and closure of a patent foramen ovale. This is a particularly rare case, especially in such a young patient. Because this is a rare diagnosis, with insufficient data, there is no formally established treatment guideline. However, in patients who are good surgical candidates, studies have shown better outcome with surgical embolectomy as compared to anticoagulation alone or thrombolysis. Fitzgerald Shepherd, Ashley White-Stern, Oloruntobi Rahaman, Damian Kurian, and Karen Simon Copyright © 2017 Fitzgerald Shepherd et al. All rights reserved. ST-Segment Elevation Myocardial Infarction and Normal Coronary Arteries after Consuming Energy Drinks Thu, 19 Jan 2017 10:47:52 +0000 http://www.hindawi.com/journals/cric/2017/4061205/ The use of energy drinks, which often contain stimulants, is common among young persons, yet there have been few reports of adverse cardiac events. We report the case of a 27-year-old man who was admitted to our facility with an acute ST-segment elevation myocardial infarction in the setting of using energy drinks. Angiography revealed no obstructive coronary disease. The patient had elevation of cardiac troponin. Noninvasive testing with echocardiography and cardiac magnetic resonance imaging demonstrated both abnormalities in resting wall motion at the anterior apex along with late gadolinium enhancement of the anterior wall, respectively. The patient also underwent formal invasive evaluation with an intracoronary Doppler study demonstrating normal coronary flow reserve and acetylcholine provocation that excluded endothelial dysfunction and microvascular disease. The patient recovered and has abstained from consuming additional energy drinks with no reoccurrence of symptoms. A review of some of the potential cardiac risks associated with consuming energy drinks is presented. S. Michael Gharacholou, Nkechinyere Ijioma, Emma Banwart, and Freddy Del Carpio Munoz Copyright © 2017 S. Michael Gharacholou et al. All rights reserved.