Cardiogenic shock in a patient with hypothyroid myopathy responsive only to thyroxin replacement: a case report.

The effect of hypothyroidism on the cardiovascular system has been well documented. Cardiac dysfunction due to hypothyroidism manifests as both systolic and diastolic dysfunction of the heart leading to cardiac arrhythmia and congestive heart failure. Its presentation in the form of refractory hypotension is rare. We describe a 52 year old man on whom Hypothyroid Cardiomyopathy manifested as cardiogenic shock responsive only to thyroxin replacement.

Hypercalcemia-leukocytosis syndrome in a patient with cavitating squamous cell carcinoma of the lung.

INTRODUCTION: Lung cancer is the leading cause of death among the cancers seen in the United States. Hypercalcemia and leukocytosis are two common paraneoplastic syndromes associated with lung cancer. Unfortunately patients presenting with Hypercalcemia- leukocytosis syndrome has a worse prognosis than patients presenting with lung cancer alone. CASE PRESENTATION: We present a 67 yr old Caucasian male with a history of active smoking presenting as pneumonia being diagnosed as cavitating squamous cell carcinoma of the lung with hypercalcemia-leukocytosis syndrome CONCLUSION: There should be a high degree of suspicion to diagnose lung cancer in patients presenting with symptoms of paraneoplastic syndrome.

Hyperkalaemic paralysis presenting as ST-elevation myocardial infarction: a case report.

BACKGROUND: Hyperkalaemic paralysis due to renal failure is a rare but potentially life threatening event. CASE PRESENTATION: We present a patient who had sudden onset ascending flaccid paralysis. The EMS first diagnosis was acute ST-elevation myocardial infarction based on an EKG. In the emergency room (ER) due to careful history taking, serum electrolytes and repeat EKG a correct diagnosis was made and both hyperkalemia and paralysis were treated on time. CONCLUSION: Hyperkalaemic paralysis is rare. One must keep it in the back of the mind especially in the case of renal failure patients to avoid misdiagnosing a rapidly fatal but yet completely reversible condition.

Paravalvular mitral valve leakage presenting as congestive heart failure, missed by TTE but diagnosed by TEE: a case report.

BACKGROUND: Diagnosis of prosthetic valve leakage by the transthoracic echocardiogram (TTE) technique is more difficult. These limitations are diminished with the use of transesophageal echocardiogram (TEE) techniques. CASE REPORT: A 71 year old Caucasian male presented with symptoms and signs of congestive heart failure. Past medical history included a bio-prosthetic mitral valve replacement for severe mitral regurgitation. TTE showed possible mitral regurgitation. As the TTE did not correlate with the finding of a high E-velocity, a TEE was performed, which showed a significant paravalvular leak of moderate severity around the bio-prosthetic mitral valve. CONCLUSION: There should be a high degree of suspicion to diagnose a paravalvular leak.

Anterolateral papillary muscle rupture caused by myocardial infarction: A case report.

BACKGROUND: The rupture of the anterolateral papillary muscle is less common than the posteromedial papillary muscle since the anterolateral muscle has dual blood supplies, while the posteromedial papillary muscle has a single blood supply. CASE PRESENTATION: We present a case report of a 42 year old male presenting with heart failure being diagnosed to have mitral regurgitation from the partial rupture of the anterolateral papillary muscle due to coronary artery disease. The patient underwent a mitral valve replacement and concomitant coronary artery bypass grafting of the first and the second obtuse marginal arteries. CONCLUSION: Acute mitral regurgitation can be precipitated by acute myocardial infarction due to rupture of the anterolateral papillary muscle.

Isolated diffuse hyperplastic gastric polyposis presenting with severe anemia.

INTRODUCTION: Gastric polyps exist in a wide variety of types, most of which are small and often benign. Discovery of gastric polyps during Endoscopy necessitates biopsies. CASE PRESENTATION: We present a case report of an isolated diffuse hyperplastic gastric polyposis in a 26 years old Hispanic female when she was investigated for profound anemia. The Esophagogastroduodenoscopy revealed numerous gastric polyps filling the entire stomach. She was treated with near-total gastrectomy and her anemia resolved CONCLUSION: Isolated diffuse hyperplasic gastric polyposis with normal gastrin level is a rare entity and can present with severe anemia.

Takotsubo cardiomyopathy in a 68-year old Russian female.

INTRODUCTION: Takotsubo cardiomyopathy also known as transient left ventricular apical ballooning, stress-induced cardiomyopathy can present with retrosternal chest pain with EKG changes that can mimic a myocardial infraction. CASE PRESENTATION: We present a 68 female with sudden onset retrosternal squeezing chest pain with positive cardiac enzymes and EKG changes suggestive of acute ST-elevation myocardial infraction. Patient was thrombolysed and cardiac cauterization done later showed normal coronaries with ballooning of the left ventricle apex. CONCLUSION: Takotsubo cardiomyopathy is a very rare disease entity yet can present to the emergency room as acute myocardial infraction.