A Case of Peripartum Ventricular Tachycardia due to Arrhythmogenic Right Ventricular Dysplasia

Arrhythmogenic right ventricular cardiomyopathy is a predominantly inherited structural disease with a heterogeneous set of implicated genetic defects. For those patients not identified by targeted population screening programs, ventricular tachycardia can be their first presentation. We report a case of a female from the genetically isolated Hutterite colonies who presented with recurrent ventricular tachycardia. She was found to be homozygous for a truncated desmocollin-2 gene, with both severe right ventricular dysfunction and left ventricular involvement. Her medical management was complicated by the finding of concomitant pre-term pregnancy. Management options for arrhythmia suppression and treatment are reviewed taking into account her decompensated biventricular dysfunction and possible fetal effects.

New and Emerging Technology in Cardiovascular Therapeutics

The last decade has seen the introduction of a number of important technological innovations in the management of advanced cardiovascular disease. These include transcatheter aortic valve replacement systems, a transcatheter mitral valve repair device, a left atrial appendage occluder device, coronary bioresorbable vascular scaffolds, leadless fully implantable pacemaker systems, wireless implantable pulmonary artery pressure monitors, transcatheter left ventricular assist pumping devices, drug-coated balloons, and robotic percutaneous coronary intervention devices. With the exception of drug coated balloon platforms, all have been utilized in our institution for patients from South Dakota and neighboring states. The objective of this study is to briefly describe these innovative devices, summarize the evidence for their benefit, and offer helpful pearls for the primary care providers who are key members of the care team for these patients.

Extranodal Rosai-Dorfman Disease Presenting as a Pericardial Mass and Constrictive Pericarditis

Rosai-Dorfman disease is a rare, idiopathic disorder of histiocyte proliferation. We describe a case of a 59-year-old woman who presented with heart failure symptoms from a large pericardial mass causing constrictive pericarditis. Pathologic findings including immunohistochemistry suggested the diagnosis. She was treated with corticosteroids and improved clinically. (Level of Difficulty: Advanced.)

Non-Rheumatic Mitral Annular Calcification as a Cause of Late-Onset Mitral Stenosis

While 'senile' calcific mitral stenosis is a rare cause of mitral stenosis as compared with rheumatic heart disease worldwide, it is thought to be more common in developed nations. Due to differences in the mechanism of dysfunction compared to rheumatic mitral stenosis, treatment options for senile calcific mitral stenosis are more limited and technically challenging. We describe a case of symptomatic severe mitral stenosis that was managed by surgical bioprosthetic valve replacement.

Isolated Quadricuspid Aortic Valve as a Cause of Insufficiency-Predominant Aortic Valve Disease

Quadricuspid aortic valve is a rare cause of symptomatic aortic regurgitation. It tends to present earlier than degenerative native valve aortic regurgitation but with similar symptoms. The condition can occur in isolation or in association with other congenital cardiac abnormalities. Surgical intervention before the development of left ventricular failure is critical to improve long term survival. We describe a case of severe aortic regurgitation due to isolated quadricuspid valve morphology that was treated surgically.

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

The entrapment of coronary intervention devices within the coronary vasculature is a rare but potentially devastating procedural complication. We report a case of an entrapped balloon and broken shaft that had to be retrieved by an open surgical approach. When device extraction is indicated and the use of snaring equipment is unsuccessful or inappropriate, a number of alternative percutaneous maneuvers can be attempted. These include (1) simple advancement and withdrawal of a trapped balloon, (2) use of a "buddy" wire to straighten the vessel and free the trapped device, (3) inflation of a buddy balloon adjacent to a trapped primary balloon to free the device, (4) partial inflation of a buddy balloon distal to a trapped device followed by gentle withdrawal, (5) use of an in-guide secondary balloon to trap the lost device, (6) advancement and twisting of guidewires to entwine the lost device, (7) saline dilution of trapped balloons, and (8) anchoring balloon and reverse-wire puncture of an undeflated and entrapped primary balloon. Careful consideration of various device retrieval strategies is indicated before resorting to open surgical retrieval in the rare instance of intracoronary device entrapment.

Post-Complex Myocardial Infarct Pseudoaneurysm Rupture and Subsequent Complications

Ventricular pseudoaneurysm is an uncommonly encountered complication of myocardial infarction (MI) in the era of percutaneous coronary intervention. Its presentation can be very non-specific, and diagnosis requires a high index of suspicion. Urgent surgical repair is generally warranted to prevent potentially catastrophic complications. We present a case of patient who presented several days after his index MI. He was ultimately diagnosed with a ruptured pseudoaneurysm, and despite best efforts had a complicated hospital course.

Amiodarone Refractory Electrical Storm Post-Revascularization for Anterior ST Elevation Myocardial Infarction: A Case Report and Brief Review of the Literature

"Electrical storm" is a life-threatening condition defined as the occurrence of at least two episodes of malignant ventricular arrhythmia in a 24-hour period despite anti-arrhythmic therapy. It leads to unpredictable degrees of clinical instability - in the most severe cases mechanical support for circulation and oxygenation and for definitive therapy radiofrequency ablation or cardiac sympathetic denervation. We describe a case of medication refractory electrical storm complicating severe left ventricular dysfunction after an anterior ST-elevation myocardial infarction.

Iatrogenic propagation of coronary dissection during diagnostic coronary angiography: an uncommon but important procedural consideration

Spontaneous coronary artery dissection is an uncommon cause of acute myocardial infarction in the general population but is relatively more common in the peripartum period. Regardless of clinical setting, the management strategy is individualised, ranging from conservative to invasive. We report a case of peripartum myocardial infarction due to spontaneous coronary dissection that propagated during diagnostic angiography and ultimately required emergent bypass surgery.

Azo Dyes Based on 2-Naphthol-Formaldehyde Oligomer

A series of new oligomeric disperse dyes were prepared by coupling various diazonium salts of aryl ether to a 2-naphthol-formaldehyde oligomer. They were characterized in terms of their softening points, colour, solubility and infrared and UV–visible spectral studies. The structural property relationships were discussed. The dyeing on polyester and nylon resulted in yellow, orange and pink-to-redcolouration having good to excellent light-fastness and washing-fastness properties.

The role of vitamin supplementation in the prevention of cardiovascular disease events

The production, sale, and consumption of multiple vitamins is a multibillion-dollar industry. Most Americans take some form of supplement ostensibly for prevention of cardiovascular disease. It has been claimed that vitamin A retards atherogenesis. Vitamin C is an antioxidant and is thought to possibly decrease free radical-induced endothelial injury, which can lead to atherosclerotic plaque formation. Vitamin E has been extensively studied for its possible effects on platelet function as well as inhibition of foam-cell formation. Low levels of vitamin D have been thought to negatively impact myocardial structure and increase the risk for cardiovascular events. Increased intake of vitamin B6, B12, and folate has been associated with reduction of homocysteine levels; elevated homocysteine blood levels have been associated with the occurrence of stroke, heart attack, and cardiovascular death. The purpose of this study was to review the currently available literature for vitamin supplementation with respect to prevention of cardiovascular disease. Unfortunately, the current evidence suggests no benefit exists with vitamin supplementation in the general US population. Further research is needed to evaluate whether there are specific populations that might benefit from vitamin supplementation.

Comparative evaluation of anticonvulsant activity of calcium channel blockers in experimental animals

Pentylenetetrazole (PTZ)-induced convulsions and the maximal electroshock (MES) seizure test were employed to study the anticonvulsant effects of nifedipine (2, 3.5 and 5 mg kg-1), flunarizine (10, 20 and 40 mg kg-1) and diltiazem (10, 15 and 30 mg kg-1). Nifedipine and flunarizine prolonged the latent period and reduced the mean duration of PTZ induced seizures. They also reduced the severity of convulsions and the number of deaths due to PTZ significantly. Nifedipine was more potent in this regard (P < 0.01). All these drugs prolonged the latent period and reduced the duration of tonic extensor phase of MES seizures in a significant manner. Flunarizine was most potent in this test. Complete protection from tonic extensor phase was observed in 10-50% animals pretreated with nifedipine and flunarizine in a dose dependent manner. The response of diltiazem was weak in both these tests. It is concluded that all three calcium channel blockers possess an important but different anticonvulsant effect and their significant clinical use can be made while keeping in view the characteristics of their pharmacological action.