Mahaim fibers coexisting with coarctation of aorta and bicuspid aortic valve

We found a coexistence of Mahaim fibers, coarctation of aorta and bicuspid valve in a young patient presenting with palpitations and subraventricular tachycardia. This rare combination of these three congenital cardiac abnormalities occurring in the same patient has not been reported previously. Detailed cardiac studies unmasked the patient's cardiac abnormalities. Furthermore, successful percutaneous intervention in treating coarctation and catheter-based ablation of Mahaim fibers were performed with resolution of symptoms. This case is discussed here in detail, alongside a review of the literature.

AV nodal reentrant tachycardia with a 2:1 right bundle branch block missed as bidirectional ventricular tachycardia in the first superficial evaluation

A 95-year old woman was admitted to our emergency unit because of acute abdominal pain. After urgent surgery according to the acute abdomen, she was referred to intensive care unit (ICU) of the emergency unit as she was intubated. It was developed a run of new arrhythmia which was diagnosed by cardiology resident as bidirectional ventricular tachycardia due to beat to beat changing the axis of the QRS. However, a second and more precise evaluation of the abnormal ECG suggested a narrow supraventricular tachycardia, most probably AV nodal reentrant tachycardia with a 2:1 right bundle branch block.

Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction

BACKGROUND

Impaired coronary artery reflow after primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction has been associated with postintervention adverse effects. Thus, finding an easily achievable index would be of great value to predict no-reflow phenomenon. In this regard, platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) have been introduced. In this study, we aimed to investigate correlation of PLR and NLR with thrombolysis in myocardial infarction (TIMI) frame count.

MATERIALS AND METHODS

A total of 215 consecutive patients with ST-segment elevation myocardial infarction (STEMI) were recruited. Pre-intervention laboratory tests were performed. Moreover, PLR and NLR were calculated for each patient. Ultimately, TIMI frame count was assessed subsequent to primary PCI for each patient.

RESULTS

We found that both PLR and NLR are correlated with TIMI frame count (R: 0·372, P < 0·001 and R: 0·301, P < 0·001, respectively). Furthermore, it was revealed that both PLR and NLR are positively correlated with corrected TIMI frame count (R: 0·388, P < 0·001 and R: 0·290, P < 0·001, respectively).

CONCLUSIONS

PLR and NLR are two easily calculated and efficient indexes for predicting the no-reflow phenomenon in patients with STEMI undergoing PPCI. Therefore, they might be employed in accurate risk stratification when a patient is a candidate for PPCI and in accurately referring patients who would benefit greatly from PPCI.

Evaluation of pentraxin-3 level and its related factors in patients undergoing primary percutaneous coronary intervention

BACKGROUND

Inflammation has an important role in the development and progression of atherosclerosis, and acute phase proteins such as pentraxin-3 (PTX3) can be deployed in determining the prognosis of coronary artery disease (CAD). So the purpose of this paper was to evaluate the PTX3 level and its related factors in patients undergoing primary percutaneous coronary intervention (PCI).

METHODS

In this cross-sectional study, the PTX3 levels were determined for 100 patients with ST-elevation myocardial infarction referred to the Modarres Hospital, Tehran, Iran. Checklist included demographic data [age, gender, history of myocardial infarction (MI)] and characteristics of heart disease (type of MI, culprit, and pre-dilation). PTX3 was measured for all patients before PCI.

RESULTS

In this study, the mean age of the participants was 58.7 (11.4). Global registry of acute coronary events (GRACE) score was higher in the group with abnormal PTX3 levels (P = 0.008). The number of the involved vessels (P = 0.005), MI type (P = 0.05), and the need for PCI all had a significant relation with abnormal PTX3 levels. The increased levels of PTX3 received higher Killip class, lower ejection fraction, and higher GRACE score. The group with abnormal PTX3 had a significant difference in platelet counts (P = 0.018) in comparison with the group with normal level of PTX3.

CONCLUSION

Currently, the biomarkers are highly important in the field of cardiovascular diseases. The diagnostic and prognostic importance of PTX3 as a new marker has been underscored in recent studies. Differentiating between high-risk patients with acute cardiac infarction and low-risk ones through their clinical signs is difficult.

Anomalous Origin of a Stenosed Left Circumflex Coronary Artery in a Patient Presenting with Unstable Angina: A Case Report

73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX) was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention.

Takotsubo cardiomyopathy following recurrent doses of albuterol due to asthma attack: a very rare case report

To present an unusual case in order to clarify one of the most important differential diagnoses of ST-elevation myocardial infarction in a postmenopausal woman. A 72-year-old woman with asthma attack and retrosternal chest pain was presented to our emergency unit. She had used albuterol spray ten-times before admission due to accentuated dyspnea. Initial ECG revealed ST-segment elevation in leads V1-V6, I and aVL. Emergent coronary angiography indicated normal coronary arteries, and left ventriculography showed significant akinesia of apical segments. This unusual case emphasizes the fact that emergency physicians and cardiologists should be familiar with Takotsubo cardiomyopathy following overuse of β₂-agonist due to asthma attack that can mimic ST-elevation myocardial infarction.

Resistant Hypertension due to Fibromuscular Dysplasia in a Young Male: A Rare Case Report

Fibromuscular Dysplasia (FMD) is a sporadic non-atherosclerotic disease. FMD has been established in nearly every arterial bed. However, the most frequent arteries affected are the renal and carotid arteries. Disease presentation may vary broadly, depending upon the arterial bed complication and the severity of illness. Hypertension, particularly resistant type, headache and dizziness are the most common presentations. String of beads appearance in angiographic views due to post-stenotic aneurysms is the characteristic view. It is most commonly described in young aged females; but in rare male cases has also been reported. Moreover, balloon angioplasty is standard and effective therapy for FMD. We present a young 28-year-old man who was referred for evaluation of resistant hypertension for nearly 3 years without comprehensive workup. The patient underwent renal artery angiography which confirmed beading narrowing of the right renal artery with significant stenosis at mid portion compatible with FMD; and balloon angioplasty was done. This case highlights that FMD should be kept in mind as a rare cause of resistant hypertension in young males; although it is most common in young females.

Subcapsular liver hematoma after fibrinolytic therapy for acute myocardial infarction: a rare case report

Hemorrhagic complications of thrombolytic therapy are rare but also serious and sometimes life-threatening. Liver hematoma is a very uncommon complication following thrombolytic therapy. We present a rare case of sub-capsular liver hematoma following streptokinase therapy of acute myocardial infarction as a challenging condition. This case report highlights that emergency physicians and cardiologists should be familiar with the significant and uncommon complications of thrombolytic agents, particularly streptokinase which is used generally in under- developed countries.

Acute ST-segment elevation myocardial infarction as the first manifestation of essential thrombocytosis successfully treated with thrombectomy alone

A patient with no conventional cardiovascular risk factors presented with inferior ST-elevation myocardial infarction which was finally diagnosed as a case of essential thrombocytosis. This case demonstrated that thrombectomy alone was sufficient for the treatment of his coronary occlusion. Furthermore, this case report highlights the importance of evaluating rare causes of myocardial infarction other than atherosclerosis and that internists and cardiologists should be aware of essential thrombocytosis as a known cause of myocardial infarction, particularly in patients with no underlying cardiovascular risk factors.