Radial Arteriovenous Fistula Formation After Transradial Cardiac Catheterization.

More than one million cardiac catheterization procedures are performed each year in the United States for both diagnostic and therapeutic purposes. Obtaining access through the radial artery has gained popularity in recent years due to its economic as well as its morbidity and mortality benefits over femoral artery access. However, with any invasive procedure there are associated risks, including arteriovenous fistula formation.

Visualized Embolization of Inferior Vena Cava Thrombus During the Abdominal Compression Maneuver to Evaluate for a Patent Foramen Ovale.

• IVC compression is an alternative to Valsalva to confirm the presence of a PFO. • A drawback of this method is reduced IVC compression in obese patients. • Use with caution in patients with low cardiac output and gastrointestinal diseases.

A Rare Case of Iatrogenic Inverted Stress Cardiomyopathy.

We discuss a case of a 42-year-old female who was admitted for chronic intractable lower back pain requiring elective spinal surgery. Postoperatively, she experienced chest pressure and abdominal pain with a notable elevation in cardiac markers. A cardiac catheterization and left ventriculogram revealed normal coronary arteries and basal anterolateral hypokinesis, with the normal movement of the distal segment of the anterior wall.

Sinoatrial Nodal Artery Arising from the Right Posterolateral Artery: A Rare Anatomical Variant.

We discuss a case report of a 66-year-old male with no prior cardiac history who presented to the hospital with persistent hiccups and shortness of breath. Following a positive nuclear stress test and cardiac catheterization, a rare anatomical variant of a sinoatrial nodal artery originating from the right posterolateral artery was revealed.

A Case of Intracardiac Thrombus in a Recovery Coronavirus Disease 2019 (COVID-19) Patient.

Coronavirus disease 2019 (COVID-19) was thought to mainly affect the respiratory system. However, studies have shown that it can be associated with hypercoagulability leading to thromboembolism. Although venous thromboembolism is a common complication associated with COVID-19, arterial thrombosis and intracardiac thrombosis are not frequently described.

Atypical Presentation of Descending Aortic Dissection in an Acute Heart Failure Patient.

Aortic dissection is relatively uncommon, but often presents with acute severe chest or back pain and acute hemodynamic compromise and is associated with high mortality. We present a case of aortic dissection with an atypical presentation in a heart failure patient and the challenges encountered to make the diagnosis. The patient was a 54-year-old African American female who presented with progressively worsening exertional dyspnea and orthopnea for three days and sensation of indigestion and bloating.

Corrected QT Interval Prolongation, Elevated Troponin, and Mortality in Hospitalized COVID-19 Patients.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has risen to the level of a global pandemic. Growing evidence has proven the cardiac involvement in SARS-CoV-2 infection. This study aims to evaluate the ability of cardiovascular complications determined by elevated troponin and electrocardiogram findings (e.

Massive Mobile Left Ventricular Thrombus in a Patient With Normal Left Ventricular Systolic Function.

• Left ventricular thrombi (LVT) formation is associated with impaired LVEF. • LVT are extremely rare among patients with normal ejection fraction. • LVT may be clinically silent but may also present with embolization.

Elevated troponin in patients with acute stroke - Is it a true heart attack?

Although the prognostic value of a positive troponin in an acute stroke patient is still uncertain, it is a commonly encountered clinical situation given that Ischemic Heart Disease (IHD) and cerebrovascular disease (CVD) frequently co-exist in the same patient and share similar risk factors. Our objectives in this review are to (1) identify the biologic relationship between acute cerebrovascular stroke and elevated troponin levels, (2) determine the pathophysiologic differences between positive troponin in the setting of acute stroke versus acute myocardial infarction (AMI), and (3) examine whether positive troponin in the setting of acute stroke has prognostic significance. We also will provide an insight analysis of some of the available studies and will provide guidance for a management approach based on the available data according to the current guidelines.

Menopausal hormone treatment in postmenopausal women: risks and benefits.

Our objectives in this review were to examine the relevant menopausal hormone treatment (MHT) trials in postmenopausal women during the past 3 decades, provide an insight analysis of these studies from a clinical point of view, determine the efficacy and applicability of hormone therapy in the prevention of cardiovascular diseases, and provide suggestions on the use of MHT as a cardiovascular disease prophylaxis based on the available data. MHT may have a more complicated role in cardiovascular protection, and there is a need for further research to elucidate the dose and type of estrogen, its route of administration, the time of MHT initiation, and the preventive role of MHT in women's health.

Diastolic function improves after resolution of takotsubo cardiomyopathy.

Background: Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) systolic dysfunction. However, the diastolic function (DF) manifestations of TTC have not been widely investigated. We performed a bicentric study with retrospective analysis of DF in patients with TTC, during onset and at follow-up.

Resolution of ischemia with β-blocker in a patient with anomalous right coronary artery.

Anomalous origin of right coronary artery (RCA) has been associated with angina, myocardial infarction and sudden death. Often these patients are referred for surgery. However, long-term β-blocker therapy instead of surgery has been used in some cases with success.

Syncope, widened QRS interval, and left ventricular systolic depression: coincident with propafenone therapy for atrial fibrillation.

We report the case of a 46-year-old man who developed syncope, a widened QRS interval, and depressed left ventricular systolic function during propafenone therapy for atrial fibrillation. These acute findings may have been consequent to an increased dosage of propafenone combined with heavy alcohol consumption that led to decreased metabolism of propafenone. In addition, propafenone is known to interfere with liver function, although this patient's test results showed scant evidence of liver abnormalities.

Cor triatriatum with single atrium presenting in adulthood.

We present the case of an asymptomatic 21-year-old woman referred because of an abnormal routine electrocardiogram. Transthoracic and transesophageal echocardiography revealed a complete absence of the atrial septum, a common atrium septated posteriorly from the pulmonary venous chamber, a partial atrioventricular canal, a cleft mitral valve and a persistent left superior vena cava draining into an enlarged coronary sinus. These findings were confirmed during surgical correction.

Breath markers of oxidative stress in patients with unstable angina.

Cardiac chest pain is accompanied by oxidative stress, which generates alkanes and other volatile organic compounds (VOCs). These VOCs are excreted in the breath and could potentially provide a rational diagnostic marker of disease. The breath methylated alkane contour (BMAC), a 3-dimensional surface plot of C4-C20 alkanes and monomethylated alkanes, provides a comprehensive set of markers of oxidative stress.

Effect of oxygen on breath markers of oxidative stress.

Supplemental oxygen is often administered to induce hyperoxia in nonhypoxic patients for indications such as chest pain, despite lack of evidence of clinical benefit. Induced hyperoxia is potentially toxic, since it may increase oxidative stress and peroxidative damage to deoxyribonucleic acid, lipids and proteins. The aim of this study was to establish whether supplemental oxygen induces oxidative stress in nonhypoxic subjects.

Assessment of acute right ventricular dysfunction induced by right coronary artery occlusion using echocardiographic atrioventricular plane displacement.

Right ventricular (RV) systolic function analysis by echocardiography has traditionally required RV endocardial border definition with subsequent tracing and is often inaccurate or impossible in technically poor studies. The atrioventricular plane displacement (AVPD) method attempts to use the descent of the tricuspid annular ring, a reflection of the longitudinal shortening of the right ventricle, as a surrogate marker for RV systolic function. We hypothesized that RV ischemia induced during right coronary artery occlusion proximal to the major right ventricular branches would result in severe right ventricular systolic dysfunction detectable by the AVPD method.

Spontaneous intramural atrial hematoma presenting as a left atrial mass.

We describe an unusual case of spontaneously occurring intramural atrial hematoma with no communication with either atrium. The diagnosis of left atrial mass was made from transthoracic echocardiography. Subsequent examination with transesophageal echocardiography confirmed a large mass essentially filling the whole left atrium but failed to provide an etiologic diagnosis, which was eventually made at surgery.

An electrocardiographic algorithm for the prediction of the culprit lesion site in acute anterior myocardial infarction.

Background: Although the 12-lead electrocardiogram (ECG) has been found useful in identifying the left anterior descending (LAD) coronary artery as the infarct-related artery in acute myocardial infarction (MI), it has traditionally been felt to be incapable of localizing the culprit lesion within the LAD itself. Such a capability would be important, because anterior MI due to proximal LAD lesions carry a much worse prognosis than those due to more distal or branch vessel lesions.

Hypothesis: This study investigated whether certain ECG variables--especially an ST-segment injury pattern in leads aVL and/or V1--would correlate with culprit lesion site, and an ECG algorithm was developed to predict culprit lesion site.

Anomalous origins of the left coronary arteries from the right sinus of valsalva with an unusual course.

We report and attempt to classify a previously undescribed coronary artery anomaly. Our patient had all three coronary arteries arising from a common ostium in the right sinus of Valsalva, with an unusual distribution to the left coronary artery system: the anomalous left circumflex system taking an intraseptal (intramyocardial) course and the anomalous left anterior descending system taking an interarterial (between the great vessels) course.

Estimation of left ventricular systolic function by nonvolumetric echocardiographic analysis in subjects with poor left ventricular visualization: a pilot study.

Background: Accurate assessment of left ventricular (LV) systolic function is an essential requirement in clinical cardiology. Several echocardiographic methods provide quantitative analysis of LV volumes and ejection fraction (EF) based on the precise tracing of endocardial borders. Often, however, technically limited studies prohibit such direct analysis, and alternative techniques must be applied.

Use of two-dimensional echocardiography in detection of an aberrantly placed transvenous pacing catheter.

The clinical usefulness and general ease of insertion of transvenous pacing catheters have made this procedure popular. It is sometimes difficult, yet important, to precisely locate the electrode tip. This report describes a patient in whom two-dimensional echocardiography was used to locate an aberrantly placed pacing catheter, whose position could not be established by conventional studies.

Two-dimensional echocardiographic localization of a malpositioned pacing catheter.

The precise intracardiac localization of transvenous pacing catheter electrodes is sometimes difficult yet crucial to patient management. We describe a patient in whom standard indirect studies failed to locate a malpositioned pacing catheter. Two-dimensional (2-D) echocardiographic examination revealed its entire aberrant course, from the right atrium, across the interatrial septum, through the mitral valve and on to the apex of the left ventricle.