Successful treatment of cardiac sarcoidosis based on clinical suspicion and advanced cardiac imaging: A case report.

Introduction: Confirming the diagnosis of cardiac sarcoidosis (CS) is a challenging task as we often do not count with histopathologic evidence. However, prompt initiation of treatment is sometimes necessary, and advanced cardiac imaging along with key clinical findings can play a crucial role in the diagnostic workup.

Patient Concerns: A 77-year-old male with a history of heart failure presented with chest pain and shortness of breath.

Acute Severe Mitral Regurgitation Secondary to Ischemic Papillary Muscle Rupture: A Case Report.

Mitral valve rupture secondary to ischemic papillary muscle necrosis is rare in the contemporary era due to improved revascularization techniques. However, when it does occur, prompt diagnosis and urgent surgical intervention can be lifesaving. A 69-year-old male with morbid obesity, hypothyroidism, and a family history of coronary artery disease presented to the hospital with chest pain and dyspnea that began five hours prior.

Achilles Tendon Xanthoma Thickness and Carotid Intima-Media Thickness in a Patient With Heterozygous Familial Hypercholesterolemia on PCSK9 Inhibition: A Case Report and Literature Review.

Ultrasound-guided measurement of carotid intima-media thickness can be used as a surrogate marker to predict future risk of atherosclerotic cardiovascular disease, and to understand the efficacy of lipid-lowering drugs. Aggressive lipid-lowering drugs such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to reduce carotid artery plaque burden, total cholesterol, and low-density lipoprotein-c in patients with heterozygous familial hypercholesterolemia (FH). We describe a patient with heterozygous FH treated with PCSK9 inhibitor over the course of two years, and the drug's impact on carotid intima-media thickness, Achilles tendon thickness, and cardiovascular disease risk reduction.

Pericardial effusion with tamponade - an uncommon presentation leading to the diagnosis of eosinophilic granulomatosis polyangiitis: A case report.

Background: Eosinophilic granulomatosis polyangiitis (EGPA) is a small vessel necrotizing vasculitis that commonly presents as peripheral eosinophilia and asthma; however, it can rarely manifest with cardiac involvement such as pericarditis and cardiac tamponade. Isolated pericardial tamponade presenting as the initial symptom of EGPA is exceedingly rare. Early diagnosis and appropriate treatment are crucial to prevent life-threatening outcomes.

Concordance and Discordance of Echocardiographic Parameters Recommended for Assessing the Severity of Mitral Regurgitation.

Background: The American College of Cardiology/American Heart Association and American Society of Echocardiography guidelines recommend assessing several echocardiographic parameters when evaluating mitral regurgitation (MR) severity. These parameters can be discordant, making the assessment of MR challenging. The degree to which echocardiographic parameters of MR severity are concordant is not well studied.

Usefulness of Mitral Regurgitant Volume Quantified Using Magnetic Resonance Imaging to Predict Left Ventricular Remodeling After Mitral Valve "Correction".

MRI studies have shown a tight correlation between mitral regurgitant volume and left ventricular end-diastolic volume (LV EDV) in patients with primary chronic mitral regurgitation (MR). They have also shown a tight correlation between regurgitant volume and the decrease in LVEDV following mitral valve surgery. The purpose of this study is to validate an empiric calculation that can be used preoperatively to predict the amount of left ventricular remodeling following mitral valve correction.

A Rare Desmoglein-2 Gene Mutation in Arrhythmogenic Right Ventricular Cardiomyopathy Inciting Incessant Ventricular Fibrillation.

A case of a 51-year-old female with history of hypertension and a significant family history of premature coronary artery disease presented to the hospital after cardiac arrest. She successfully completed a targeted temperature management therapy with full neurologic recovery. Her hospital course was complicated by several bouts of ventricular fibrillation (VF) arrest which was rescued by timely defibrillation, high quality cardiorespiratory resuscitation, and administration of antiarrhythmic medications and inotropic agents.

Utilization of Echocardiogram, Carotid Ultrasound, and Cranial Imaging in the Inpatient Investigation of Syncope: Its Impact on the Diagnosis and the Patient's Length of Hospitalization.

Background: Although guidelines suggest that the best strategy for evaluating syncope is clinical history and physical examination, the inappropriate utilization of diagnostic imaging is common.

Methods: A single center retrospective analysis conducted in adult patients admitted for evaluation and management of syncope for a period of 12 months. Charts were reviewed to abstract demographic data, admitting and discharge diagnosis, diagnostic investigatory tests including imaging modalities (echocardiogram, carotid ultrasound, and cranial computed tomography (CT)) ordered, subspecialty consultation requested, treatment rendered and hospital length of stay (LOS).

Brockenbrough-Braunwald-Morrow Sign: An Evaluative Hemodynamic Maneuver for Left Ventricular Outflow Tract Obstruction.

A case of a 77-year-old woman with a history of hypertrophic cardiomyopathy (HCM) presented with intermittent episodes of exertional dyspnea and chest discomfort. Her coronary angiogram revealed normal coronary arteries but with hypertrophic obstructive cardiomyopathy with an increasing left ventricular-aortic gradient on isoproterenol provocation. Likewise, an intensified gradient was observed after a premature ventricular contraction (PVC) that is distinguished as the Brockenbrough-Braunwald-Morrow sign substantiating confirmation of left ventricular outflow tract (LVOT) obstruction.

High Grade Atrioventricular Block in Von Recklinghausen Disease: A Rare Phenomenon.

A case of a 73-year-old woman with a history of von Recklinghausen disease (neurofibromatosis type 1) who presented initially with a gradual onset of shortness of breath and lightheadedness with no associated fever, chills, angina, palpitations, cough, weight loss, night sweats, nausea, vomiting, or constipation. She was found to be severely bradycardic and in third degree atrioventricular block by her primary care physician. She was admitted in the hospital because of intermittent bouts of lightheadedness and progression of the shortness of breath.

A Rare Case of Native Mitral Valve Endocarditis Culminating Into a Cerebrovascular Infarction.

We report a case of a 56-year-old man who presented initially with a sudden onset of right-sided facial droop and weakness, aphasia, and confusion with no associated fever, chills, syncope, fatigue, weight loss, night sweats, nausea, vomiting, diarrhea, odontalgia, palpitations, cough, or dyspnea. Code stroke was called and the patient received tissue plasminogen activator (tPA) with subsequent resolution of his symptoms. Cranial magnetic resonance imaging showed left frontal punctate cortical restricted diffusion consistent with subacute to acute infarction.

Angio-Seal™ Embolization: A Rare Etiology of an Acute Distal Limb Ischemia.

We herein report a serious vascular complication of diagnostic cardiac catheterization due to an embolization of an Angio-Seal closure device causing acute lower limb ischemia. The Angio-Seal was deployed via the right femoral artery following the catheterization which embolized several hours later to the right popliteal artery. Fogarty embolectomy restored perfusion to the right lower limb; however, compartment syndrome subsequently developed which required evacuation of a hematoma and repair of right popliteal artery.

A Very Late Presentation of a Right Coronary Artery Occlusion After Transcatheter Aortic Valve Replacement.

Involvement of the coronary ostia is a rare complication after transcatheter aortic valve replacement (TAVR). This complication has been more commonly described immediately after valve deployment. This is the first reported case of delayed coronary obstruction caused by TAVR 6 months after the procedure.

Heterozygous Familial Hypercholesterolemia With APOE Haplotype: A Prospective Harbinger of a Catastrophic Cardiovascular Event.

We report a very young man with heterozygous familial hypercholesterolemia (FH) with APOE haplotype and a significant cardiac family history who underwent cardiac catheterization for intermittent episodes of exertional dyspnea and was noted to have a severe triple vessel coronary artery disease (CAD). He underwent coronary artery bypass graft (CABG) surgery which was uneventful. He was discharged on antiplatelet, beta blocker, nitrate, and statin.

Cough induced syncope: A hint to cardiac tamponade diagnosis.

We report a case of a 75-year-old male with history of lung adenocarcinoma who presented with shortness of breath and frequent episodes of cough-induced syncope. A large pericardial effusion was found on echocardiogram suggestive of cardiac tamponade. Pericardiocentesis was done which improved the dyspnea and eventually resolved the syncope.

Concomitant Left Atrial Myxoma and Patent Foramen Ovale: Is It an Evolutional Synergy for a Cerebrovascular Event?

We report a case of a 48-year-old female who presented initially with an abrupt onset of left facial and hand numbness after her routine yoga with no associated syncope, palpitation, chest pain or dyspnea. She consulted her primary care physician and recommended hospital care for possible stroke. On the day of admission, she complained of left facial and hand hemiparesthesia.

Mediterranean Spotted Fever: A Rare Non-Endemic Disease in the USA.

We report a case of a 43-year-old Israeli male who presented with an intermittent fever associated with a gradual appearance of diffusely scattered erythematous non-pruritic maculopapular lesions, generalized body malaise, muscle aches, and distal extremity weakness. He works in the Israeli military and has been exposed to dogs that are used to search for people in tunnels and claimed that he had removed ticks from the dogs. In the hospital, he presented with fever, a diffuse maculopapular rash, and an isolated round black eschar.

A Rare Case of Tolosa-Hunt-Like Syndrome in a Poorly Controlled Diabetes Mellitus.

We report a case of a 50-year-old female with diabetes mellitus who presented with progressive second, third, fifth, sixth, and eighth cranial nerve palsy. Diagnostic investigation revealed hyperglycemic state, and brain imaging showed a right cavernous sinus enhancement suggestive of and consistent with Tolosa-Hunt syndrome. The patient was started on steroids with tight glycemic control for eight weeks; subsequently, the cranial nerve palsies resolved as well as documented resolution of the right cavernous sinus enhancement.

Symptomatic Trifascicular Block in Steinert's Disease: Is It Too Soon for a Pacemaker?

We report a case of a 62-year-old male with Steinert's disease who presented with progressive intermittent episodes of lightheadedness five years after he was diagnosed with the disease. On evaluation, he developed a new onset trifascicular block (first degree atrioventricular block, new onset right bundle branch block, and left anterior fascicular block). A dual chamber pacemaker was inserted and lightheadedness improved significantly.