Case Reports in Cardiology https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Right Atrial Fibroelastoma Presenting as Typical Atrial Flutter: Rare Disease in Unusual Location Tue, 10 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/4764587/ Typical atrial flutter as initial presentation of papillary fibroelastoma involving the cavotricuspid isthmus is not described before in literature. To our knowledge only 14 cases have been reported in literature involving the right atrium. Very unusual location is at the junction between inferior vena cava (IVC) and right atria as only 1 case has been reported. Ahmad Abuarqoub, Ghada Elshimy, Muhammed Shittu, Aiman Hamdan, and Fayez Shamoon Copyright © 2017 Ahmad Abuarqoub et al. All rights reserved. D-Shaped Left Ventricle, Anatomic, and Physiologic Implications Sun, 08 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/4309165/ Right ventricular loading/pressure influences left ventricular function because the two ventricles pump in series and because they are anatomically arranged in parallel, sharing the common ventricular septum. Flattening of the interventricular septum detected during echocardiographic examination is called D-shaped left ventricle. We present a case of an elderly male of African descent, who presented with increased shortness of breath. Transthoracic echocardiogram showed flattening and left sided deviation of interventricular septum causing a decreased size in left ventricle, secondary to volume/pressure overload in the right ventricle. While patient received hemodialysis therapy and intravascular volume was removed, patient blood pressure was noted to increase, paradox. Repeated transthoracic echocardiogram demonstrated less left deviation of interventricular septum compared with previous echocardiogram. We consider that it is important for all physicians to be aware of the anatomic and physiologic implication of D-shaped left ventricle and how right ventricle pressure/volume overload affects its function and anatomy. Eder Hans Cativo Calderon, Tuoyo O. Mene-Afejuku, Rachna Valvani, Diana P. Cativo, Devendra Tripathi, Hans A. Reyes, and Savi Mushiyev Copyright © 2017 Eder Hans Cativo Calderon et al. All rights reserved. Parachute-Like Mitral Valve Tuberculoma: A Rare Presentation Sun, 08 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/1023924/ There have been anecdotal reports of tuberculous cardiac involvement, mainly in cases of military tuberculosis or immune deficient individuals. The spectrum of clinical presentations of tuberculous cardiac involvements includes incidental detection of single and multiple well-circumscribed tuberculomas, symptomatic obstructive lesions, AV conduction abnormalities, and even sudden death. We present a case of cardiac tuberculoma in an immune-competent person who presented with worsening dyspnea. The unique morphology of this mass posed an imaging challenge that required 4-dimensional (4D) echocardiography and cardiac magnetic resonance (CMR) detail to differentiate the mass from an anterior mitral leaflet (AML) aneurysm. Histological examination after surgical resection confirmed its tuberculous etiology. Arslan Masood, Gul Zaman Khan, Irfan Bashir, and Zubair Akram Copyright © 2017 Arslan Masood et al. All rights reserved. Postintervention Dyspnea after Radiofrequency Catheter Ablation: Think of a Phrenic Nerve Injury Wed, 04 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/6418070/ Phrenic nerve injury (PNI) is a rare complication of catheter ablation therapy, most commonly observed in cryoablation of the right side pulmonary veins. We present a case of PNI after radiofrequency catheter ablation that developed acute dyspnea 24 hours after the intervention. Dyspnea is the main symptom of PNI, so the diagnosis should always be suspected if it appears after any type of catheter ablation involving the trajectory of the phrenic nerve. There is no specific treatment for PNI. The only maneuver that has been reported to accelerate the recovery of PNI is early stopping of the ablation therapy. Liliana E. Ramos-Villalobos, Luis Colin Lizalde, Manlio F. Márquez, Pedro Iturralde, and Francisco Castillo Copyright © 2017 Liliana E. Ramos-Villalobos et al. All rights reserved. Coronary Artery Hematoma Treated with Fenestration Using a Novel NSE Alpha® Scoring Balloon Mon, 02 Oct 2017 05:52:59 +0000 http://www.hindawi.com/journals/cric/2017/8189530/ The optimal management of coronary intramural hematoma has not been defined. We described a case in which coronary occlusion developed due to an intramural hematoma after percutaneous coronary intervention for mid left circumflex artery (LCX). Intravascular ultrasound (IVUS) demonstrated the progression of the intramural hematoma and a totally compressed true lumen. Our approach was based on fenestration with a scoring balloon (NSE Alpha, Goodman, Japan), which allowed the deployment of an additional stent to be avoided. In conclusion, this management can be effectively and safely performed. Naohiro Funayama, Takao Konishi, Tadashi Yamamoto, and Daisuke Hotta Copyright © 2017 Naohiro Funayama et al. All rights reserved. Epoetin Alfa: A Cause of Coronary Artery Thrombosis Sun, 01 Oct 2017 08:02:57 +0000 http://www.hindawi.com/journals/cric/2017/9475180/ Introduction. Epoetin alfa is an erythrocyte-stimulating factor. We here present a case of an anemic patient, who was given epogen before a coronary artery bypass (CABG) surgery and developed periprocedural myocardial infarction. To our knowledge, there has been no previous case reported of epogen causing myocardial infarction. Case Presentation. 66-year-old female presented with substernal chest pain. EKG showed ST segment elevations in aVf and L-III. Patient underwent left heart catheterization (LHC) and had triple vessel disease. A bare metal stent was placed in RCA. Patient continued to have symptoms after discharge and presented to the ED again with these complaints. She underwent coronary artery bypass surgery (CABG). Before the procedure, patient’s hemoglobin was 11.1 grams/deciliter and was given epogen to raise hemoglobin level. Postoperative day (POD) #1 patient had ST elevations in inferior and anterolateral leads. She was diagnosed with periprocedural myocardial infarction. Patient underwent repeat LHC, which identified obstruction of saphenous vein graft (SVG). Hypercoagulable workup was negative for any disease and the patient was diagnosed with epogen induced early graft occlusion. Conclusion. Epogen administration can cause myocardial infarction and coronary artery thrombosis. We suggest that physicians use epogen very cautiously, especially in population who has underlying coronary artery disease. Muhammad Umer Siddiqui, Yelena Galumyan, James Klein, Zunaira Naeem, and Aron Schwarcz Copyright © 2017 Muhammad Umer Siddiqui et al. All rights reserved. Case Report of Multiembolic Cerebrovascular Event Associated with Ramp Study Echocardiogram Thu, 28 Sep 2017 08:43:45 +0000 http://www.hindawi.com/journals/cric/2017/9072523/ The incidence of ramp test echocardiogram-associated embolic events in the setting of therapeutic anticoagulation is likely rare and has not been reported. We present such a case in a patient with a HeartMate II left ventricular assist device (LVAD) whose serial head computed tomography images, deteriorating clinical course, and the multiembolic nature of the event suggest causality. If the pretest probability of pump thrombosis in an individual LVAD patient is sufficiently high, the potential risks of performing a ramp study echocardiogram may not be warranted, even in the setting of adequate anticoagulation. Brian C. Butera, Luanda P. Grazette, Tracy Lawrence, Michael E. Bowdish, and Andrew J. Yoon Copyright © 2017 Brian C. Butera et al. All rights reserved. Aorto-Right Ventricular Shunt after TAVR: Rare Complication of Common Procedure Thu, 28 Sep 2017 07:19:05 +0000 http://www.hindawi.com/journals/cric/2017/1834394/ Background. The primary treatment of symptomatic aortic stenosis is aortic valve replacement. Instead of open chest surgery, transcatheter aortic valve replacement (TAVR) is an alternative intervention for high-risk surgical candidates. Clinical Case. A 92-year-old male presented with progressive exertional dyspnea and recurrent syncopal attacks secondary to severe AS. The patient underwent successful transfemoral TAVR with 29 mm Edwards SAPIEN XT valve. His postoperative course was complicated by aorto-right ventricular shunt. The patient’s clinical course was followed up for one year. Conclusion. This case reports the incidence and clinical course of one of the rare complications of TAVR, aorto-right ventricular fistula. Conservative medical management is appropriate in hemodynamically stable patients with this specific complication. Abdelkader Almanfi, Ahmad Qurie, and Neil Strickman Copyright © 2017 Abdelkader Almanfi et al. All rights reserved. A Rare Association of Takotsubo Cardiomyopathy with High-Degree Atrioventricular Block Wed, 20 Sep 2017 07:03:41 +0000 http://www.hindawi.com/journals/cric/2017/6989438/ Here we present a case of a patient who got trapped in an elevator; on initial evaluation patient was found with bradycardia; on further evaluation electrocardiogram (EKG) showed new onset 2nd-degree Mobitz type 2 AV block. On admission patient developed ischemic changes on EKG and troponin elevation. Transthoracic echocardiogram showed reduced ejection fraction as well as apical inferior, anterior, lateral, and septal hypokinesia. Coronary angiography showed nonobstructive coronary artery disease and ventriculogram demonstrated anterolateral and apical hypokinesia suggesting takotsubo cardiomyopathy (TCM). Atrioventricular block (AV) is rarely seen as initial presentation of TCM and has a prevalence of about 2.9%. AV block during early presentation of TCM poses a therapeutic dilemma with regard to the timing and the need to place a temporary or permanent pacemaker. The decision to place a permanent pacemaker may be on a case-by-case basis and more research is needed on formulating standardized recommendations in patients with TCM and conduction tissue abnormalities. Eder Hans Cativo, Rachna Valvani, Tuoyo O. Mene-Afejuku, Diana P. Cativo, and Savi Mushiyev Copyright © 2017 Eder Hans Cativo et al. All rights reserved. H. capsulatum: A Not-So-Benign Cause of Pericarditis Thu, 07 Sep 2017 07:54:27 +0000 http://www.hindawi.com/journals/cric/2017/3626917/ The common causes of pericarditis and its course are benign in the majority of cases. Thus, further testing is usually not pursued and treatment for a presumptive viral etiology with nonsteroidal agents and steroids has been an accepted strategy. We present a patient with pericarditis who was unresponsive to first-line therapy and was subsequently found to have necrotizing granulomas of the pericardium with extensive adhesions and fungal elements seen on tissue biopsy. Serologic testing confirms active H. capsulatum infection, and he responded well to Itraconazole treatment. In patients with pericarditis who fail standard therapy with NSAIDs and steroids, it is suggested that they undergo thorough evaluation and that histoplasmosis be considered as an etiology, especially in endemic regions. Paolo K. Soriano, Muhammad Iqbal, Shakthishri Kandaswamy, Sami Akram, Abhishek Kulkarni, and Tamer Hudali Copyright © 2017 Paolo K. Soriano et al. All rights reserved. Revascularization of Chronic Total Occlusion of the Infrarenal Aorta in a Patient with Triple Vessel Disease: Report of a Case Treated by Endovascular Approach Wed, 06 Sep 2017 10:03:45 +0000 http://www.hindawi.com/journals/cric/2017/7983748/ Surgical management of advance aortoiliac occlusive disease is time-tested and a widely practiced strategy, particularly when there is significant coronary artery disease associated with aortoiliac occlusive disease. The technological advances in the field of percutaneous techniques have facilitated the use of nonsurgical endovascular alternatives for peripheral arterial disease in patients with significant comorbidities at high surgical risk, as illustrated in our case report. We report a case of chronic total occlusion of the aorta that was treated percutaneously with endovascular stenting. We also discuss the specific technique used in this procedure. Mahek Shah, Soumya Patnaik, Rahul Sinha, Issac Opoku-Asare, Khalid Chaudhry, and Sean Janzer Copyright © 2017 Mahek Shah et al. All rights reserved. Persistent Unexplained Dyspnea: A Case of Hepatopulmonary Syndrome Tue, 29 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/1469893/ Regarding a patient with dyspnea, the history and physical examination often lead to the correct diagnosis. In some circumstances, when more than one underlying disease is present, the diagnostic process can be more challenging. We describe an unusual case of dyspnea and persistent hypoxemia related to a hepatopulmonary syndrome in a 53-year-old patient with known heart failure and chronic liver disease. Initially managed with intravenous diuretic therapy, due to signs of lung and peripheral congestion, our patient did not improve as expected; therefore we performed more advanced studies with a chest-abdomen CT scan and a right heart catheterization. They showed, respectively, no signs of parenchymal and vasculature lung disease, a cirrhotic liver disease, splenomegaly, signs of portal hypertension, and high cardiac output with normal pulmonary vascular resistance. These results, along with the association of hypoxemia and chronic liver disease, suggested a hepatopulmonary syndrome. The diagnosis was confirmed by the demonstration of an intrapulmonary vascular dilatation with right to left shunt during a microbubble transthoracic echocardiography and a lung perfusion scan. Liver transplantation is the only successful treatment for this syndrome; however, the patient became soon unsuitable for this strategy, due to a rapid clinical deterioration. Alfonso Campanile, Alessandro Colombo, Maurizio Del Pinto, and Claudio Cavallini Copyright © 2017 Alfonso Campanile et al. All rights reserved. An Unusual Case of Recurrent Hypersensitivity Reaction Associated with Kounis-Like Acute Coronary Syndrome Sun, 27 Aug 2017 10:10:41 +0000 http://www.hindawi.com/journals/cric/2017/6421208/ There have been multiple reports of allergic reactions associated with acute coronary syndromes. This has been classically described as Kounis syndrome. We present an unusual case of 70-year-old male with multiple prior hypersensitivity reactions and history of coronary artery bypass grafting who presented recurrent episode of severe angioedema and anaphylaxis. He responded to epinephrine but subsequently developed a non-ST elevation myocardial infarction with worsening heart failure. Our case is unique in that, unlike classic Kounis syndrome, the acute coronary event in this case did not present concurrently with the allergic reaction; rather it took nearly 48 hours to present. Subsequent angiogram revealed patent grafts and significant decline in the left ventricular systolic function as compared to his own ECHO a year ago. We postulate that slow mediators of inflammation may play a role in delayed development of acute coronary events with associated LV dysfunction following episodes of angioedema and anaphylaxis. Shanker Kundumadam, Vivek Reddy, Sagar Mallikethi Reddy, Pradeep Kathi, and Aiden Abidov Copyright © 2017 Shanker Kundumadam et al. All rights reserved. An Incidentally Detected Right Ventricular Pseudoaneurysm Thu, 24 Aug 2017 06:46:58 +0000 http://www.hindawi.com/journals/cric/2017/4352474/ Ventricular pseudoaneurysm is an uncommon, potentially fatal complication that has been associated with myocardial infarction, cardiac surgery, chest trauma, and infectious processes. Diagnosis can be challenging, as cases are rare and slowly progressing and typically lack identifiable features on clinical presentation. As a result, advanced imaging techniques have become the hallmark of identification. Ahead, we describe a patient who presents with acute decompensated heart failure and was incidentally discovered to have a large right ventricular pseudoaneurysm that developed following previous traumatic anterior rib fracture. Vamsi C. Gaddipati, Angel I. Martin, Mauricio O. Valenzuela, Asef Mahmud, and Aarti A. Patel Copyright © 2017 Vamsi C. Gaddipati et al. All rights reserved. Isolated Persistent Left Superior Vena Cava, Sick Sinus Syndrome, and Challenging Pacemaker Implantation Thu, 24 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/9842524/ Persistent left superior vena cava with absent right superior vena cava is a very rare venous anomaly and is known as isolated PLSVC. It is usually an asymptomatic anomaly and is mostly detected during difficult central venous access or pacemaker implantation, though it could also be associated with an increased incidence of congenital heart disease, arrhythmias, and conduction disturbances. Herein, we describe a dual-chamber pacemaker implantation in a patient with isolated PLSVC and sick sinus syndrome. Hatice S. Kemal, Aziz Gunsel, Levent Cerit, Murat Kocaoglu, and Hamza Duygu Copyright © 2017 Hatice S. Kemal et al. All rights reserved. Electromagnetic Interference from Swimming Pool Generator Current Causing Inappropriate ICD Discharges Wed, 23 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/6714307/ Electromagnetic interference (EMI) includes any electromagnetic field signal that can be detected by device circuitry, with potentially serious consequences: incorrect sensing, pacing, device mode switching, and defibrillation. This is a unique case of extracardiac EMI by alternating current leakage from a submerged motor used to recycle chlorinated water, resulting in false rhythm detection and inappropriate ICD discharge. A 31-year-old female with arrhythmogenic right ventricular cardiomyopathy and Medtronic dual-chamber ICD placement presented after several inappropriate ICD shocks at the public swimming pool. Patient had never received prior shocks and device was appropriate at all regular follow-ups. Intracardiac electrograms revealed unique, high-frequency signals at exactly 120 msec suggestive of EMI from a strong external source of alternating current. Electrical artifact was incorrectly sensed as a ventricular arrhythmia which resulted in discharge. ICD parameters including sensing, pacing thresholds, and impedance were all normal suggesting against device malfunction. With device failure and intracardiac sources excluded, EMI was therefore strongly suspected. Avoidance of EMI source brought complete resolution with no further inappropriate shocks. After exclusion of intracardiac interference, device malfunction, and abnormal settings, extracardiac etiologies such as EMI must be thoughtfully considered and excluded. Elimination of inappropriate shocks is to “first, do no harm.” Edward Samuel Roberto, Thein Tun Aung, Atif Hassan, and Abdul Wase Copyright © 2017 Edward Samuel Roberto et al. All rights reserved. Chagas Cardiomyopathy Presenting as Symptomatic Bradycardia: An Underappreciated Emerging Public Health Problem in the United States Wed, 16 Aug 2017 06:31:22 +0000 http://www.hindawi.com/journals/cric/2017/5728742/ Chagas cardiomyopathy (CCM) is traditionally considered a disease restricted to areas of endemicity. However, an estimated 300,000 people living in the United States today have CCM, of which its majority is undiagnosed. We present a case of CCM acquired in an endemic area and detected in its early stage. A 42-year-old El Salvadoran woman presented with recurrent chest pain and syncopal episodes. Significant family history includes a sister in El Salvador who also began suffering similar episodes. Physical exam and ancillary studies were only remarkable for sinus bradycardia. The patient was diagnosed with symptomatic sinus bradycardia and a pacemaker was placed. During her hospital course, Chagas serology was ordered given the epidemiological context from which she came. With no other identifiable cause, CCM was the suspected etiology. This case highlights the underrecognized presence of Chagas in the United States and the economic and public health importance of its consideration in the etiological differential diagnosis of electrocardiographic changes among Latin American immigrants. While the United States is not considered an endemic area for Chagas disease, the influx of Latin American immigrants has created a new challenge to identify at-risk populations, diagnose suspected cases, and provide adequate treatment for this disease. Richard Jesse Durrance, Tofura Ullah, Zulekha Atif, William Frumkin, and Kaushik Doshi Copyright © 2017 Richard Jesse Durrance et al. All rights reserved. Spontaneous Coronary Artery Dissection: A Rare Manifestation of Alport Syndrome Mon, 14 Aug 2017 06:35:40 +0000 http://www.hindawi.com/journals/cric/2017/1705927/ Alport syndrome (AS) is a genetic disorder due to inheritance of genetic mutations which lead to production of abnormal type IV collagen. AS has been associated with renal, auditory, and ocular diseases due to the presence of abnormal alpha chains of type IV collagen in the glomerulus, cochlea, cornea, lens, and retina. The resulting disorder includes hereditary nephritis, corneal opacities, anterior lenticonus, fleck retinopathy, temporal retinal thinning, and sensorineural deafness. Aortic and aortic valve pathologies have been described as extrarenal manifestations of AS in multiple case reports. One case report described intramural hematoma of the coronary artery. We report the first case of true spontaneous coronary artery dissection (SCAD) with an intimal flap as a very rare manifestation of AS. The patient is a 36-year-old female with history of AS with chronic kidney disease, hypertension, and obesity who presented to the emergency room with acute onset of substernal chest pain radiating to her neck and arms. Troponin was elevated, and ECG showed transient 1 mm ST-segment elevation in the inferior leads. Subsequent coronary angiography revealed localized dissection of the left circumflex artery. Percutaneous coronary angioplasty was performed and her symptoms improved. This case illustrates that SCAD may be a manifestation of AS patients with chest pain. Amornpol Anuwatworn, Prince Sethi, Kelly Steffen, Orvar Jonsson, and Marian Petrasko Copyright © 2017 Amornpol Anuwatworn et al. All rights reserved. The Use of a Novel Heart Failure Agent in the Treatment of Pregnancy-Associated Cardiomyopathy Mon, 14 Aug 2017 06:16:17 +0000 http://www.hindawi.com/journals/cric/2017/9561405/ Peripartum cardiomyopathy is an uncommon, pregnancy-related form of dilated cardiomyopathy that is associated with development of new-onset left ventricular dysfunction. Its etiology is presently unknown, but current standard of care involves the use of typical drug therapy for the treatment of heart failure. Pregnancy-associated cardiomyopathy (PACM) is a similar condition that refers to patients who develop such symptoms prior to the last month of pregnancy. We report the case of a nulliparous Caucasian female who develops early, severe PACM during her first pregnancy with postpartum persistence of New York Heart Association class II-III symptoms despite medical therapy. The use of the novel heart failure agent, sacubitril/valsartan (Entresto), is initiated with near-complete resolution of her symptoms. Vamsi C. Gaddipati, Aarti A. Patel, and Adam J. Cohen Copyright © 2017 Vamsi C. Gaddipati et al. All rights reserved. Sequential Venous Percutaneous Transluminal Angioplasty and Balloon Dilatation of the Interatrial Septum during Percutaneous Edge-to-Edge Mitral Valve Repair Wed, 09 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/3652413/ Percutaneous edge-to-edge mitral valve repair (PMVR) is widely used for selected, high-risk patients with severe mitral valve regurgitation (MR). This report describes a case of 81-year-old woman presenting with severe and highly symptomatic mitral valve regurgitation (MR) caused by a flail of the posterior mitral valve leaflet (PML). PMVR turned out to be challenging in this patient because of a stenosis and tortuosity of both iliac veins as well as sclerosis of the interatrial septum, precluding the vascular and left atrial access by standard methods, respectively. We managed to achieve atrial access by venous percutaneous transluminal angioplasty (PTA) and balloon dilatation of the interatrial septum. Subsequently, we could advance the MitraClip® system to the left atrium, and deployment of the clip in the central segment of the mitral valve leaflets (A2/P2) resulted in a significant reduction of MR. Rezo Jorbenadze, Johannes Patzelt, Meinrad Gawaz, Peter Seizer, and Harald F. Langer Copyright © 2017 Rezo Jorbenadze et al. All rights reserved. Detection of a Left Superior Vena Cava during a Pacemaker Implantation in Cotonou Tue, 08 Aug 2017 06:48:14 +0000 http://www.hindawi.com/journals/cric/2017/7634082/ Persistent left superior vena cava (LSVC) is a rare congenital anomaly. Its prevalence in the general population is 0.1 to 0.5%. LSVC is 5 times rarer when accompanied by an absence of the right superior vena cava (RSVC). We present the case of a 54-year-old man who carries a persistent LSVC without RSVC. Clinically, this patient presented a regular bradycardia at 40 per minute associated with a heart failure syndrome. The electrocardiogram diagnosed a complete atrioventricular block and transthoracic echocardiography showed dilated left heart cavities and a left ventricular ejection fraction of 50%. During the procedure of pacemaker implantation, the probe followed an unusual LSVC-coronary sinus-right atrium path and it was not easy to pass through the tricuspid orifice. We propose a review of the literature on this subject, focusing on the clinical implications of this malformation in cardiac stimulation and in other areas of cardiology. A. Sonou, M. Hounkponou, L. Codjo, P. M. Adjagba, C. Houehanou, H. Dohou, S. Assani, Y. Tchabi, and M. Houenassi Copyright © 2017 A. Sonou et al. All rights reserved. Leukemic Ischemia: A Case of Myocardial Infarction Secondary to Leukemic Cardiac Involvement Mon, 07 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/7298347/ We report a case of a 39-year-old male who presented to the emergency department with acute chest pain while being in remission from T-cell acute lymphoblastic leukemia (T-ALL). Cardiac markers were elevated and EKG revealed ischemic changes compatible with acute myocardial ischemia. Coronary computed tomography angiography (CCTA) showed calcium-free coronary arteries and soft tissue myocardial infiltration suggestive of cardiac leukemia. A bone marrow biopsy confirmed recurrence of T-ALL, and patient was successfully treated with chemotherapy. We discuss the prospective diagnosis of myopericardial leukemic involvement and the role of CCTA in diagnosis and perform a literature review. Dzmitry Fursevich, Colin Zuchowski, Joseph Limback, Melissa Kendall, Ashley Ramirez, Naim Fanaian, and Jeremy Burt Copyright © 2017 Dzmitry Fursevich et al. All rights reserved. Alveolar Soft Part Sarcoma with Unusual Cardiac Metastasis: A Case Report and Review of the Literature Sun, 06 Aug 2017 08:33:21 +0000 http://www.hindawi.com/journals/cric/2017/7248727/ Alveolar soft part sarcoma is a very uncommon soft tissue malignancy which accounts for <1% of soft tissue sarcoma. It is a malignant and highly vascular tumor arising most commonly in the musculature of the lower extremities, with metastasis primarily to the lungs, bones, and brain. Cardiac metastasis is very rare and only 5 cases have been reported in the literature so far. We report a case of a young woman with a history of surgically resected alveolar soft part sarcoma of left thigh who presented with persistent dry cough and was found to have a cardiac mass, which on biopsy proved to be alveolar soft part sarcoma. Abhinav Tiwari, Bhavana Siddegowda Bangalore, Himani Sharma, Zaid Ammari, Mohammad S. Khan, Zubair Khan, and Hermann Simo Copyright © 2017 Abhinav Tiwari et al. All rights reserved. Symptomatic Long Pauses and Bradycardia due to Massive Multinodular Goiter Sun, 06 Aug 2017 08:19:38 +0000 http://www.hindawi.com/journals/cric/2017/4201942/ Sinus node dysfunction with symptomatic bradycardia or chronotropic incompetence is generally an indication for pacemaker implantation. However, in patients with symptomatic sinus bradycardia, the identification and treatment of underlying pathologies may avoid the need for permanent pacemaker implantation. We present a case of carotid sinus syndrome and severe obstructive sleep apnea due to a massive multinodular goiter in a patient who presented with recurrent sinus pauses and syncope. The patient was managed without pacemaker implantation but instead with thyroidectomy resulting in decompression of the carotid sinus and airway and resolution of bradycardic episodes. Amrish Deshmukh and Cevher Ozcan Copyright © 2017 Amrish Deshmukh and Cevher Ozcan. All rights reserved. Acute Heart Failure Exacerbation with Cardiogenic Shock and Elevated Systemic Vascular Resistance Treated with a Combination of Nicardipine and Dobutamine Therapy Sun, 06 Aug 2017 06:33:51 +0000 http://www.hindawi.com/journals/cric/2017/7329213/ Acute heart failure is a common reason for hospital admission and is usually caused by decreased cardiac output either as a result of an intrinsic cardiac issue or as a result of severe hypertension with elevated afterload. We present a patient with a history of HFrEF who presented with acute heart failure, found to have hypotension requiring Dobutamine support and an elevated systemic vascular resistance requiring Nicardipine drip, with subsequent recovery of cardiac function. Lydia E. Issac, Setri Fugar, Naser Yamani, and Burhan Mohamedali Copyright © 2017 Lydia E. Issac et al. All rights reserved. Neuropsychological Outcome following Resuscitation after Out-of-Hospital Cardiac Arrest: A One-Year Follow-Up Sun, 06 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/7283606/ A 61-year-old woman survived resuscitation after out-of-hospital cardiac arrest. The heterogeneity of the resulting cognitive impairments and the recovery over a one-year period are presented, highlighting the need for standardized neuropsychological testing even after short cardiac arrests and for effective treatment both out of hospital and in hospital. Jeannette Overbeck and Frank-Michael Schweers Copyright © 2017 Jeannette Overbeck and Frank-Michael Schweers. All rights reserved. Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem Sun, 06 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/5434571/ A forty-year-old man experienced worsening heart failure four years following bilateral complicated total hip replacement. His condition was extensively worked up but no underlying pathology was immediately evident. Given the cobalt-chromium alloy component present in the hip arthroplasties, the raised cobalt blood levels, and a fitting clinical picture coupled with radiological findings, the patient underwent right hip revision. Evidence of biotribocorrosion was present on direct visualisation intraoperatively. The patient subsequently experienced symptomatic improvement (NYHA class III to class I) and echocardiography showed recovery of ejection fraction. Cobalt exists as a bivalent and trivalent molecule in circulation and produces a cytotoxicity profile similar to nanoparticles, causing neurological, thyroid, and cardiological pathology. Blood levels are not entirely useful as there is no identifiable conversion factor for levels in whole blood, serum, and erythrocytes which seem to act independently of each other. Interestingly cobalt cardiomyopathy is frequently compounded by other possible causes of cardiomyopathy such as alcohol and a link has been postulated. Definitive treatment is revision of the arthroplasty as other treatments are unproven. Russel Tilney, Melanie Roberta Burg, and Mark Adrian Sammut Copyright © 2017 Russel Tilney et al. All rights reserved. Surgery Averted Using a Novel, Minimally Invasive Approach to Treat Very Severe Radial Artery Spasm Wed, 02 Aug 2017 07:59:26 +0000 http://www.hindawi.com/journals/cric/2017/8487056/ A 42-year-old male admitted with a non-ST elevation myocardial infarction was referred for invasive angiographic assessment. Based on preprocedural assessment, the right radial artery approach was selected. Despite possessing none of the consensus risk factors for radial artery spasm, in addition to receiving standard arterial spasm prophylaxis and conscious sedation, the patient suffered very severe radial artery spasm with initial catheter placement, resulting in entrapment of a 5 Fr pigtail catheter within the left ventricle. After exhausting traditional methods for resolution of radial artery spasm, surgical intervention appeared to be the only remaining option for removal of the entrapped catheter. Prior to committing to surgery, use of an axillary nerve block to hinder sympathetic vascular tone was suggested and attempted. This intervention resulted in atraumatic catheter removal. We present a case of very severe radial artery spasm refractory to customary interventions, alleviated with a novel, minimally invasive technique, which spared surgical intervention. Anthony A. Cochet Jr. and Daniel A. Bellin Copyright © 2017 Anthony A. Cochet Jr. and Daniel A. Bellin. All rights reserved. Case Report of First Angiography-Based On-Line FFR Assessment during Coronary Catheterization Tue, 01 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/6107327/ Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressure-monitoring guide wire and hyperemic stimulus. Although it has become the standard of reference for decision-making regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. is a novel technology that uses the patient’s hemodynamic data and routine angiograms to generate a complete three-dimensional coronary tree, with color-coded display of the FFR values at each point along the vessels. After being proven to be as accurate as invasive FFR measurements in an off-line study, this case report presents the first on-line application of the system in the catheterization lab. Here too, a high concordance between and invasive FFR was observed. In light of the demonstrated capabilities of the system, it should emerge as an important tool for clinical decision-making regarding revascularization in patients with coronary artery disease. Ran Kornowski and Hana Vaknin-Assa Copyright © 2017 Ran Kornowski and Hana Vaknin-Assa. All rights reserved. Incomplete Resolution of Deep Vein Thromboses during Rivaroxaban Therapy Sun, 30 Jul 2017 08:17:35 +0000 http://www.hindawi.com/journals/cric/2017/3628127/ We present the case of a patient with a deep vein thrombosis (DVT) who failed rivaroxaban therapy. Our patient initially presented with left lower extremity edema, erythema, and pain. He was subsequently started on rivaroxaban therapy for a combined treatment period of 12 months, during and after which he persisted to have evidence of a DVT. The patient’s prescribed drug regimen was changed from rivaroxaban to warfarin, which demonstrated a rapid resolution of the DVTs as determined by ultrasound assessment of our patient’s lower extremity veins. Rivaroxaban, a factor Xa inhibitor, is a well-known oral anticoagulant that is used for a variety of indications and has become a mainstay in the treatment of deep vein thrombosis. With the introduction and emergence of this medication in the clinic, postmarketing reports of efficacy or lack thereof are important to review. In conclusion, we anticipate that it is likely that there are other patients with DVTs who may not respond to rivaroxaban and for whom alternative anticoagulation therapies should be explored. Jonathan M. Yaghoubian, Jacob Adashek, Bahareh Yaghoubian-Yazi, Menachem Nagar, Nojan Toomari, Richard J. Pietras, and Uri M. Ben-Zur Copyright © 2017 Jonathan M. Yaghoubian et al. All rights reserved.