Case Reports in Cardiology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Successful Ablation for Atrial Tachycardia Originated from Sinus Venosa with Tachycardia-Induced Cardiomyopathy Thu, 20 Oct 2016 10:07:01 +0000 A 74-year-old male suffering from congestive heart failure with atrial tachycardia (AT) with 2 : 1 atrioventricular conduction was admitted to our hospital. After the therapy with diuretics and β-blocker, his rapid AT was still sustained. He took the catheter ablation for his AT. Postpacing interval mapping from entrainment and noncontact mapping system revealed the mechanism of his AT, originated from sinus venosa. His AT was successfully terminated and eliminated by radiofrequency catheter ablation. After the successful ablation, he has been free from any AT, and his cardiac function was also improved. Sou Takenaka, Hideaki Sato, Mikio Yuhara, and Takashi Uchiyama Copyright © 2016 Sou Takenaka et al. All rights reserved. An Endomyocardial Biopsy of the Left Ventricle in an Anorexia Nervosa Patient with Sinus Bradycardia and Left Ventricular Systolic Dysfunction Wed, 19 Oct 2016 08:37:03 +0000 Anorexia nervosa (AN) is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of body weight. AN is a life-threatening condition that significantly increases the risk of death due to cardiac complications, such that at least one-third of all deaths in patients with AN are associated with cardiac causes including sudden death. In many reports, sudden death has been linked to reduced left ventricular function, structural changes, and QT abnormalities. However, the mechanistic details connecting AN to cardiac abnormalities remain unknown. Here we present an endomyocardial biopsy of the left ventricle in a case of AN with a reversible left ventricular systolic dysfunction. Satoshi Takahashi and Takanao Mine Copyright © 2016 Satoshi Takahashi and Takanao Mine. All rights reserved. Corrigendum to “A Striking Coronary Artery Pattern in a Grown-Up Congenital Heart Disease Patient” Mon, 17 Oct 2016 12:32:33 +0000 Fortunato Iacovelli, Martino Pepe, Gaetano Contegiacomo, Vito Alberotanza, Filippo Masi, Alessandro Santo Bortone, and Stefano Favale Copyright © 2016 Fortunato Iacovelli et al. All rights reserved. A Sizable Aortic Root Paravalvular Mycotic Pseudoaneurysm Tue, 11 Oct 2016 11:42:50 +0000 Mycotic aneurysm is an established condition first identified in 1885 by Sir William Osler. It is linked to malignant endocarditis. With prevalence of 0.7–2.6% of all cases of aortic aneurysms, it is associated with a significant rate of mortality and morbidity. Physicians should be highly cautious, as diagnosis and effective treatment for this condition are difficult. The following is a case report of a 13-year-old pediatric patient diagnosed with mycotic aneurysm. Before an adequate treatment plan could be developed and implemented, patient’s status worsened swiftly and was ultimately terminal. This case is the sole instance of this condition evidenced in the last ten years in Saudi Arabia. Ahmad Saeed Azhar and Noran M. Abu-Ouf Copyright © 2016 Ahmad Saeed Azhar and Noran M. Abu-Ouf. All rights reserved. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions Tue, 11 Oct 2016 08:58:11 +0000 Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS) with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease. Hans A. Reyes, Julie Islam, Soheila Talebi, Eder Cativo, Savi Mushiyev, Gerald Pekler, and Ferdinand Visco Copyright © 2016 Hans A. Reyes et al. All rights reserved. Response to: Comment on “Symptomatic Trifascicular Block in Steinert’s Disease: Is It Too Soon for a Pacemaker?” Mon, 10 Oct 2016 14:28:06 +0000 Glenmore Lasam, Roberto Roberti, Gina LaCapra, and Roberto Ramirez Copyright © 2016 Glenmore Lasam et al. All rights reserved. Successful Left Atrial Appendage Occlusion with the New Generation Amulet® Device after Late-Occurring Embolization of an Amplatzer® Cardiac Plug in a Patient with Repetitive Strokes Sun, 09 Oct 2016 12:23:20 +0000 The Amplatzer Cardiac Plug (ACP) is one of the most commonly used devices for percutaneous left atrial appendage (LAA) closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for long-term oral anticoagulation therapy. We have previously described a patient who had experienced an embolization of the ACP device about 12 months after implantation and the device could be percutaneously retrieved. A few years later, he suffered from a posterior stroke and a stroke located in the brainstem as well as a transischemic attack (TIA). In order to protect him from further cardioembolic events a reocclusion of the LAA with the new generation of ACP device, the Amplatzer Amulet, was performed. A stable position of the device within follow-up period could be confirmed and the patient was free of additional strokes/TIA or bleeding events. This case stresses the importance of proper LAA sizing in order to prevent device embolization and notes that LAA size is not static. Moreover, it demonstrates that repeated implantation of an LAA occlusion device was still possible; one should be aware of undersizing the LAA dimensions and that the modifications of new generation LAA occlusion devices may overcome limitations of first-generation devices in order to prevent a cardioembolic stroke. Marco R. Schroeter and Wolfgang Schillinger Copyright © 2016 Marco R. Schroeter and Wolfgang Schillinger. All rights reserved. Multifactorial Etiology Pulmonary Hypertension in a Patient with Sarcoidosis Sun, 09 Oct 2016 07:47:05 +0000 Differential diagnosis between pre- and postcapillary pulmonary hypertension (PH) in patients with diastolic heart failure (DHF) is a challenge in clinical practice. The presence of PH is implicated in worse prognosis in patients with this disease. This case report approaches the process of investigation of pulmonary hypertension in adult patient with DHF, double mitral lesion, and sarcoidosis with poor clinical outcome. Barreto Ana Terra Fonseca, Barreto Lucas Vinícius da Fonseca, Cavalcante Felipe Naze Rodrigues, Oliveira Joselina Luzia Menezes, Almeida-Santos Marcos Antônio, Garcez Juliane Dantas Seabra, Barreto-Filho José Augusto Soares, and Sousa Antônio Carlos Sobral Copyright © 2016 Barreto Ana Terra Fonseca et al. All rights reserved. Metastatic Calcinosis of Aortic Valve Secondary to Renal Failure Mimicking Infective Endocarditis Sun, 25 Sep 2016 09:01:43 +0000 End stage renal disease has a list of consequences, cardiovascular being the most common. Inefficient dialysis can cause significant deposition of calcium all over the body, including heart valves making heart function impaired. We illustrate a case of 38-year-old female with end stage renal disease on peritoneal dialysis. The patient had been complaining of pain and swelling of the right hand for the last few months and had been seen by hand surgeon and was admitted electively for the biopsy of hand lesions. Before her planned surgery, she developed severe shortness of breath. Urgent echocardiogram revealed severe aortic regurgitation and large vegetation on the aortic valve. Infective endocarditis was suspected but blood cultures were negative for any microorganism and the patient did not meet the Duke criteria. Because of her hemodynamic instability immediate mechanical valve replacement surgery was performed. The pathology report showed extensive calcification and myxoid degeneration. No infectious agent was found. Later on, biopsy of her hand lesions showed extensive calcification with macrophages and giant cells. No atypia or malignancy was identified. This is a rare case of the metastatic calcinosis of aortic valve secondary to renal failure mimicking aortic valve infective endocarditis. Noman Ahmed Jang Khan, Masroor A. Khan, and Guillermo Juan Morell Chardon Copyright © 2016 Noman Ahmed Jang Khan et al. All rights reserved. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review Wed, 21 Sep 2016 11:40:20 +0000 A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal. Balraj Singh, Jennifer M. Treece, Ghulam Murtaza, Samit Bhatheja, Steven J. Lavine, and Timir K. Paul Copyright © 2016 Balraj Singh et al. All rights reserved. Pseudopheochromocytoma Associated with Domestic Assault Wed, 21 Sep 2016 09:45:40 +0000 Pseudopheochromocytoma has a clinical presentation that is similar to pheochromocytoma. It manifests itself with paroxysmal hypertension crises, associated with various symptoms such as headaches, chest pain, nausea, palpitations, and dizziness. Patients are usually asymptomatic in between the crises. Unlike pheochromocytoma, there is no catecholamines overproduction in this pathology: hypertensive peaks are caused by a hyperactivation of the sympathetic nervous system, which is often triggered by a psychological trauma in the past. Treatment of pseudopheochromocytoma can be challenging due to normal blood pressure values in between the hypertensive peaks; it includes alpha- and beta-blockers for moderate crises and prevention and must be combined with psychopharmacologic agents such as anxiolytics or antidepressant drugs. Psychotherapy and dietetic treatment are also crucial in pseudopheochromocytoma management. H. M. Le, G. Carbutti, D. Ilisei, E. Bouccin, and X. Vandemergel Copyright © 2016 H. M. Le et al. All rights reserved. An Obstructed Anomalous Left Anterior Descending Coronary Artery Arising from the Right Coronary Artery Requiring Surgical Intervention Mon, 19 Sep 2016 14:16:03 +0000 A 47-year-old female presented to our hospital with symptoms of stable angina. Cardiac catheterization revealed a rare coronary artery anomaly of the left anterior descending (LAD) artery branching off the right coronary artery ostium. Furthermore, the anomalous LAD artery exhibited significant atherosclerotic obstruction. Our review of the literature found only nine such previously described cases. Due to the unique nature of coronary artery anomalies and their complications, we would like to contribute our case to the medical literature. Alexander Mironov, Sean Galligan, Aleksandre Kakauridze, and Jonathan D. Marmur Copyright © 2016 Alexander Mironov et al. All rights reserved. Successful Intravascular Ultrasound-Guided Transradial Coronary Intervention with a 4Fr Guiding Catheter Thu, 08 Sep 2016 18:04:14 +0000 Minimizing the catheter size can reduce vascular access complications and contrast dye usage in coronary angiography. The small diameter of the 4Fr guiding catheter has limited the use of several angioplasty devices such as intravascular ultrasound (IVUS) in the past. However, the combination of a novel IVUS catheter and a 0.010 guidewire makes it possible to perform IVUS-guided percutaneous coronary intervention (PCI) with a 4Fr guiding catheter. We herein report the case of a 51-year-old man with silent myocardial ischemia who underwent IVUS-guided transradial PCI with a 4Fr guiding catheter. Yasuhiro Nakano and Kenji Sadamatsu Copyright © 2016 Yasuhiro Nakano and Kenji Sadamatsu. All rights reserved. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention Wed, 07 Sep 2016 16:51:00 +0000 Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome. Abdul-rahman R. Abdel-karim, Minh Vo, Michael L. Main, and J. Aaron Grantham Copyright © 2016 Abdul-rahman R. Abdel-karim et al. All rights reserved. Successful Retrieval of a Dismembered Central Venous Catheter Stuck to the Right Pulmonary Artery Using a Stepwise Approach Wed, 07 Sep 2016 16:46:13 +0000 Recent advances in anticancer chemotherapy have resulted in an increase in the number of patients requiring a central venous port catheter, and the incidence of catheter pinch-off syndrome has been increasing. Catheter pinch-off syndrome is a rare and unusual complication. It is difficult to retrieve dislodged catheters from the pulmonary artery, especially if the catheter is stuck to the peripheral pulmonary artery. We herein describe the successful removal of a catheter stuck in the pulmonary artery with a stepwise approach. First, a pigtail catheter was used to tug the dislodged catheter in order to free the unilateral end. Then, a gooseneck snare was used to catch and pull the catheter out of the patient. The key to success is to free the end of the catheter. Keisuke Nakabayashi, Hidekimi Nomura, Daichi Isomura, Ryo Sugiura, and Toshiaki Oka Copyright © 2016 Keisuke Nakabayashi et al. All rights reserved. Comment on “A Rare Case of Renal Infarct due to Noncompaction Cardiomyopathy: A Case Report and Literature Review” Thu, 01 Sep 2016 09:41:03 +0000 Josef Finsterer and Sinda Zarrouk-Mahjoub Copyright © 2016 Josef Finsterer and Sinda Zarrouk-Mahjoub. All rights reserved. The Role of TEE in Diagnosing Hepatopulmonary Syndrome and Cryptogenic Cirrhosis Wed, 31 Aug 2016 07:34:46 +0000 In the vast majority of cases, ongoing hypoxemia in a cirrhotic patient is usually hepatopulmonary syndrome (HPS) until proven otherwise; in this case, HPS was suspected prior to any known diagnosis of cirrhosis. This is the first reported case in the literature whereby HPS and cirrhosis were diagnosed after the fact, rather than with the preexisting knowledge of liver cirrhosis. Joel Scott-Herridge, Kapil Bhagirath, Surinder Janda, and Davinder S. Jassal Copyright © 2016 Joel Scott-Herridge et al. All rights reserved. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression Mon, 29 Aug 2016 12:00:11 +0000 Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management. Fahad Almehmadi, Mark Chandy, Kim A. Connelly, and Jeremy Edwards Copyright © 2016 Fahad Almehmadi et al. All rights reserved. Ultrasound Assisted Catheter Directed Thrombolysis in the Management of a Right Atrial Thrombus: A New Weapon in the Armamentarium? Sun, 28 Aug 2016 09:25:20 +0000 Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines. Ultrasound assisted catheter directed thrombolysis emerges as promising modality with a relatively lower risk of hemorrhage compared to systemic thrombolysis. We report a case of a 75-year-old man with dialysis catheter related thrombosis without PE for which ultrasound assisted catheter directed thrombolysis was used successfully as an alternative therapy. Mohamed Shokr, Ramanjit Kaur, Kevin Belgrave, Arshad Javed, Mahir Elder, Shaun Cardozo, Luis Afonso, and Amir Kaki Copyright © 2016 Mohamed Shokr et al. All rights reserved. Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication Thu, 25 Aug 2016 06:21:18 +0000 Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion. Manuel Marina-Breysse, Alfonso Jurado-Román, Bartolomé López-Viedma, Jesús Piqueras-Flores, and María T. López-Lluva Copyright © 2016 Manuel Marina-Breysse et al. All rights reserved. A Patient with a Right Atrium Mass and Congenital Heart Disease: A Challenging Diagnosis of a Stubborn Disease Sun, 21 Aug 2016 09:07:06 +0000 Cardiac lymphoma is extremely rare. An intracardiac mass has rarely been reported to be the cardiac involvement of extranodal lymphoma. It is difficult to establish a final diagnosis via routine examinations. The ability of an echocardiogram to characterize tissue is limited; systemic (18)F-FDG PET/CT scans provide important information for both staging and response assessment in patients with lymphoma. A 68-year-old Chinese male with a second patent foramen ovale (PFO) and an interventricular septal defect presented at our institute with persistent fever, shortness of breath, repeated paroxysmal supraventricular tachycardia (PSVT) attack, and rapidly progressing superior vena cava syndrome. The patient also presented with a mass located in the upper right atrium and superior vena cava which was detected by echocardiogram. (18)F-FDG PET/CT scan revealed a pathological increase of (18)F-FDG uptake in the atrial mass and several other extracardiac lymph nodes. Lymph node biopsy was positive for large B-cell lymphoma. Immunohistochemistry revealed intense and diffuse expression of CD20, CD10, BCL-6, and Ki-67. The patient died without any chemotherapy 18 days after hospital discharge. Wenyan Wang, Huaicong Long, and Zhiying Zhao Copyright © 2016 Wenyan Wang et al. All rights reserved. Platypnea-Orthodeoxia Syndrome after Transcatheter Aortic Valve Implantation Wed, 17 Aug 2016 11:08:54 +0000 Progressive dyspnea and hypoxaemia in the subacute phase after transcatheter aortic valve implantation (TAVI) are uncommon and warrant immediate assessment of valve and prosthesis leaflet function to exclude thrombosis, as well as investigation for other causes related to the procedure, such as left ventricular dysfunction, pulmonary embolism, and respiratory sepsis. In this case, we report the observation of a patient presenting two weeks after TAVI with arterial hypoxaemia in an upright position, relieved by lying flat, and coupled with an intracardiac shunt detected on echocardiography in the absence of pulmonary hypertension, raising the suspicion of Platypnea-Orthodeoxia Syndrome (POS). Invasive intracardiac haemodynamic assessment showed a significant right-to-left shunt (Qp/Qs = 0.74), which confirmed the diagnosis, with subsequent closure of the intracardiac defect resulting in immediate relief of symptoms and hypoxaemia. To our knowledge, this is the first reported case of an interatrial defect and shunt causing Platypnea-Orthodeoxia Syndrome after transcatheter aortic valve implantation, resolved by percutaneous device closure. Andrew K. Roy, Jerome Garot, Antoinette Neylon, Marco Spaziano, Fadi J. Sawaya, and Thierry Lefèvre Copyright © 2016 Andrew K. Roy et al. All rights reserved. Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus Wed, 17 Aug 2016 09:18:04 +0000 A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy. Siddharth Wartak, Isaac Akkad, Adnan Sadiq, Gregory Crooke, Manfred Moskovits, Robert Frankel, Gerald Hollander, and Jacob Shani Copyright © 2016 Siddharth Wartak et al. All rights reserved. Comment on “Symptomatic Trifascicular Block in Steinert’s Disease: Is It Too Soon for a Pacemaker?” Mon, 15 Aug 2016 13:54:07 +0000 Josef Finsterer and Claudia Stöllberger Copyright © 2016 Josef Finsterer and Claudia Stöllberger. All rights reserved. Adult ADHD Medications and Their Cardiovascular Implications Mon, 08 Aug 2016 05:47:49 +0000 Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder exhibited by difficulty maintaining attention, as well as hyperactivity and impulsive behavior. Central nervous system (CNS) stimulants are the first line of treatment for ADHD. With the increase in number of adults on CNS stimulants, the question that arises is how well do we understand the long-term cardiovascular effects of these drugs. There has been increasing concern that adults with ADHD are at greater risk for developing adverse cardiovascular events such as sudden death, myocardial infarction, and stroke as compared to pediatric population. Cardiovascular response attributed to ADHD medication has mainly been observed in heart rate and blood pressure elevations, while less is known about the etiology of rare cardiovascular events like acute myocardial infarction (AMI), arrhythmia, and cardiomyopathy and its long-term sequelae. We present a unique case of AMI in an adult taking Adderall (mixed amphetamine salts) and briefly discuss the literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD. A. Sinha, O. Lewis, R. Kumar, S. L. H. Yeruva, and B. H. Curry Copyright © 2016 A. Sinha et al. All rights reserved. Ventricular Septal Defect from Takotsubo Syndrome Wed, 03 Aug 2016 11:42:13 +0000 Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction with apical akinesis/dyskinesis and ballooning. Although the prognosis with medical management is excellent in most cases, rare cases of serious complications can occur. We present here a case of a 71-year-old woman presenting with acute decompensated heart failure with initial findings consistent with a myocardial infarction, who was found instead to have an acute ventricular septal defect as a complication of Takotsubo Syndrome. Daniel Y. Lu, Julie Caplow, Neha Quatromoni, Rhondalyn Forde-McLean, and Anjali Tiku Owens Copyright © 2016 Daniel Y. Lu et al. All rights reserved. Cardiac Fibroelastoma versus Thrombus: Echocardiographic Evidence Can Be Misleading Sun, 31 Jul 2016 17:09:43 +0000 We present a case of a young female with stroke symptoms who underwent valve sparing resection of a presumed fibroelastoma based on echocardiographic findings. After confirming embolic stroke, she underwent excision of the lesion, which on pathology revealed a nonbacterial thrombus. Ultimately, this led to a more extensive work-up leading to the discovery of a papillary serous ovarian carcinoma, the underlying cause of her hypercoagulable state. The initial echocardiographic findings painted the clear picture of a papillary tumor on the aortic valve which was likely the source of the emboli resulting in ischemic stroke. This unique case presentation illustrates that imaging, including echocardiography, may not always coincide with the clinical diagnosis. Thus, understanding the differential diagnoses of cardiac masses is of vital clinical significance. The distinction of fibroelastoma versus the much less common finding of aortic thrombus may lead to early diagnosis of malignancy and prevention of life threatening events due to stroke or undiagnosed disease. John P. O’Laughlin, Gautam Verma, and Iosif Gulkarov Copyright © 2016 John P. O’Laughlin et al. All rights reserved. The Presence of a Large Chiari Network in a Patient with Atrial Fibrillation and Stroke Sun, 31 Jul 2016 08:04:15 +0000 The Chiari network is an embryological remnant found in the right atrium, mostly without any significant pathophysiological consequences. However, several cardiac associations are reported in the literature including supraventricular tachyarrhythmias. We present a case of a 96-year-old body donor with a stroke episode and intermittent atrial fibrillations. The dissection of the heart revealed the presence of an immense Chiari network with a large central thrombus. The role of a Chiari network in the pathogenesis of stroke and pulmonary embolism is discussed. Nneka Schwimmer-Okike, Johannes Niebuhr, Grit Gesine Ruth Schramek, Stefan Frantz, and Heike Kielstein Copyright © 2016 Nneka Schwimmer-Okike et al. All rights reserved. Noncompaction and Dilated Cardiomyopathy in a Patient with Schizophrenia Sun, 31 Jul 2016 06:32:09 +0000 Objectives. Psychosis and left ventricular hypertrabeculation (or noncompaction) (LVHT) have not been described in the same patient. Here we report a patient with a long-term history of schizophrenia who was later diagnosed with dilated cardiomyopathy (dCMP) and LVHT. Case Report. A 47-year-old Caucasian male developed nondifferentiated schizophrenia at the age of 26 y. Since the age of 33 y he was regularly drinking alcohol. At the age of 47 y he developed heart failure. Transthoracic echocardiography showed an enlarged left ventricle, reduced systolic function, and surprisingly LVHT in the apical segment. Additionally, the left atrium was enlarged, the right ventricular cavities were mildly enlarged, and there were pulmonary hypertension and a small pericardial effusion. Cardiac MRI confirmed the echocardiographic findings. Since coronary angiography was normal, dilated cardiomyopathy was additionally diagnosed. Since he was taking clozapine during years, dilated cardiomyopathy could be due to not only alcohol consumption but also the long-term neuroleptic medication. Conclusions. LVHT may be associated with nondifferentiated psychosis. Management of LVHT is challenging in patients with psychosis due to poor compliance and adherence of these patients. Patients with LVHT and psychosis need particular attention since they usually take cardiotoxic drugs for a long time, which may further deteriorate the prognosis of LVHT. Josef Finsterer and Claudia Stöllberger Copyright © 2016 Josef Finsterer and Claudia Stöllberger. All rights reserved. Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal Thu, 28 Jul 2016 11:36:00 +0000 We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA) signaling during benzodiazepine withdrawal. Teng J. Peng, Nicholas D. Patchett, and Sheilah A. Bernard Copyright © 2016 Teng J. Peng et al. All rights reserved.