Conservative treatment of spontaneous dissection of multiple coronary arteries.

A young woman who presented with chest pain was shown with CT and selective coronary angiography to have spontaneous dissections of her left anterior descending and distal right coronary arteries. She was managed with enoxaparin, aspirin, clopidogrel and metoprolol: she was well with a normal stress echocardiogram fourteen months later. Surgical intervention or angioplasty and stent deployment may be avoided in such patients if they are clinically stable.

Kaposi's sarcoma occurring in a cardiac transplant patient on tacrolimus.

Kaposi's sarcoma is a relatively rare but potentially fatal malignancy which affects immunosuppressed individuals. It has been found to occur especially in association with cyclosporine and tacrolimus use and with concurrent cytomegalovirus infection. When detected and treated early, it usually carries a good prognosis and responds well to measures increasing immunocompetence.

Spinal cord stimulation significantly improves refractory angina pectoris-a local experience spinal cord stimulation in refractory angina.

Background: Severe refractory angina pectoris can occur in end-stage coronary artery disease despite maximal medical and revascularization therapy. Spinal cord stimulation is an under-utilized but well-established modality for the treatment of intractable angina pain.

Aim: To illustrate the practical, beneficial and effective use of spinal cord stimulation as a treatment option for refractory angina in a local context.

Mycotic coronary artery aneurysm detected by gallium67 scintigraphy.

A 71-year-old man presented with fever and positive blood cultures for methicillin-sensitive Staphylococcus aureus 4 days after an uncomplicated intra-luminal abdominal aortic aneurysm repair. Investigations looking for a source of sepsis including computerized tomography scans, transoesophageal echocardiography, a bone scan and repeated chest X-rays, did not reveal an infective focus. Gallium(67) scintigraphy, however, showed a focus of tracer uptake in the region of the aorto-cardiac junction consistent with the presence of an abscess.

Infrequent syncope in a heavy vehicle driver.

We present a case study of a truck driver with sinus node dysfunction diagnosed with the help of an implantable loop recorder more than 18 months after implantation. This case emphasizes that cardiogenic syncope may be very infrequent and its diagnosis can be elusive despite extensive testing.

Novel use of sildenafil in the treatment of portopulmonary hypertension.

Portopulmonary hypertension is a poorly understood and uncommon complication of advanced chronic liver disease. Current therapy is based largely on treatment options proven in idiopathic pulmonary hypertension. The severity of the portopulmonary hypertension should best be attenuated medically before attempting combined liver and lung transplantation to avoid increased peri-operative mortality.