COVID-19 vaccines-associated Takotsubo cardiomyopathy: A narrative review.

Takotsubo cardiomyopathy (TTC) is a severe, acute, reversible, and self-limited cardiac dysfunction. It usually affects postmenopausal women and is mostly triggered by physical or emotional stressors. Following the COVID-19 pandemic, millions of doses of different types of COVID-19 vaccines are being administered globally. There have been reports of different cardiac complications after receiving COVID-19 vaccines. To our knowledge, there have been 16 reported cases of COVID-19 vaccination-associated TTC. In this study, we first provide a brief overview of TTC and then an overview of selected reported TTC cases following COVID-19 vaccinations. It is crucial to highlight that the occurrence of TTC after vaccination does not establish a direct cause-and-effect relationship between immunization and TTC. Further investigations are necessary to examine any potential association between COVID-19 vaccines and the incidence of TTC. Additionally, the benefits of receiving COVID-19 vaccines significantly outweigh the potential risks of developing adverse events.

A Nearly Missed Case of Mitral Bioprosthetic Paravalvular Leak (PVL)-Related Waring Blender Syndrome Treated With Transcatheter Mitral PVL Closure.

A 72-year-old woman with recently diagnosed non-small cell lung cancer, who underwent cardiac bypass and bioprosthetic mitral valve replacement presented to our cancer center with lightheadedness, severe fatigue, and shortness of breath. Initial blood tests showed mild hemolytic anemia. The patient also complained of occasional bright red bleeding per rectum. Esophagogastroduodenoscopy and colonoscopy did not reveal an acute source of bleeding. An initial transesophageal echocardiogram did not show significant valvular or paravalvular abnormalities. Meanwhile, the patient's hemolytic anemia worsened. She received eight units of packed red blood cell transfusions. Schematic workup for hemolytic anemia revealed negative Coomb's test, positive urine hemosiderin, normal ADAMTS13 activity, and absent splenomegaly. A relook of the patient's transesophageal echocardiogram (TEE) showed a small paravalvular leak of the bioprosthetic mitral valve. The patient was referred to a tertiary center, and repair of the perivalvular leak with glue resolved her hemolytic anemia, subsequently improving the lab values, symptoms, and quality of life. This case highlights the schematic workup of hemolytic anemia and also the importance of recognizing the association between hemolytic anemia and valvular abnormalities.

The genetics of spontaneous coronary artery dissection: a scoping review.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a multifactorial process that involves predisposing factors and precipitating stressors. Genetic abnormality has been implicated to play a mechanistic role in the development of SCAD. This systematic review aims to summarize the current evidence concerning the link between SCAD and genetic abnormalities. METHODS: We reviewed original studies published until May 2023 that reported SCAD patients with a genetic mutation by searching PubMed, Embase Ovid, and Google Scholar. Registries, cohort studies, and case reports were included if a definitive SCAD diagnosis was reported, and the genetic analysis was performed. Exclusion criteria included editorials, reviews, letters or commentaries, animal studies, meeting papers, and studies from which we were unable to extract data. Data were extracted from published reports. RESULTS: A total of 595 studies were screened and 55 studies were identified. Among 116 SCAD patients with genetic abnormalities, 20% had mutations in the COL gene, 13.70% TLN1 gene, and 8.42% TSR1 gene. Mutations affecting the genes encoding COL and TLN1 were most frequently reported (20 and 13.7%, respectively). Interestingly, 15 genes of this collection were also reported in patients with thoracic aortic diseases as well. The genetic commonality between fibromuscular dysplasia (FMD) and SCAD was also included. CONCLUSION: In this review, the inherited conditions and reported genes of undetermined significance from case reports associated with SCAD are collected. A brief description of the encoded protein and the clinical features associated with pathologic genes is provided. Current data suggested that the diagnostic yield of genetic studies for patients with SCAD would be low and routine genetic screening of such patients with no clinical features indicative of associated disorders remains debatable. This review can be used as a guide for clinicians to recognize inherited syndromic and nonsyndromic disorders associated with SCAD.

Unveiling a Critical Subacute Complication: Right Apical Septum Pacemaker Lead Dislodgement Leading to Right Ventricular Perforation and Minimal Pericardial Effusion.

The implantation of cardiac pacing devices, such as pacemakers and implanted cardioverter-defibrillators (ICDs), has significantly improved patient outcomes in the treatment of a range of cardiac arrhythmias. Right ventricular (RV) pacing lead perforation is an uncommon but potentially dangerous complication that can occur despite technical breakthroughs. RV lead perforation, which can result in right ventricular perforation as well as possible pulmonary or vascular harm, is caused by the pacing lead breaking through the myocardial wall. Despite being rare, this complication warrants attention because of the risks for morbidity and mortality that are involved. We present a case of right ventricular perforation caused by a pacemaker lead and examine the nuances of RV lead perforation in this instance, including its prevalence, clinical presentation, diagnostic difficulties, and treatment strategies, illuminating the many factors to be taken into account while properly managing this issue.

Surviving the Storm: Cardiac Tamponade and Effusive Constrictive Pericarditis Complicated by Pericardial Decompression Syndrome Induced by COVID-19 Infection in the Setting of Newly Diagnosed Acute Myeloid Leukemia (AML).

Coronavirus disease 2019 (COVID-19)-induced pericarditis and pericardial myocarditis are common entities; however, the development of pericardial effusion post-COVID-19 infection has only been reported in about 5% of cases. Rapid and acute progression to pericardial tamponade is uncommon, and progression to effusive constrictive pericarditis (ECP) and pericardial decompression syndrome (PDS) is an even rarer phenomenon. We describe these phenomena in this report to raise awareness and aid clinicians in the early diagnosis and management of these conditions. We report a case of a 45-year-old female with a past medical history of recent COVID-19 infection, uncontrolled diabetes mellitus, and hypertension who presented with severe chest pain, which was determined to be acute pericarditis post-COVID-19 infection. The patient developed a large pericardial effusion leading to cardiac tamponade within one day of initial presentation. Urgent pericardiocentesis was performed but was complicated by rapid decompensation of the patient, which has been assumed to be ECP following pericardiocentesis and PDS.  Close monitoring of acute pericarditis with pericardial effusion is required in these patients for the early detection of cardiac tamponade, which requires urgent pericardiocentesis. Judicious post-pericardiocentesis follow-up is also required for the early diagnosis of conditions such as ECP and PDS. These cases are generally managed symptomatically, but in cases of severe ECP syndrome, pericardial stripping may be required.

A Rare Occurrence of Spontaneous Coronary Artery Dissection in Elderly: Diagnostic Challenges and Clinical Implications.

Spontaneous coronary artery dissection (SCAD) is the ripping of the epicardial coronary artery wall without any trauma, coronary procedures, or rupture of atherosclerotic plaque. Intimal rip, intramural hematoma, and false lumen formation are the hallmarks of this disease, which may result in coronary blood flow obstruction and myocardial ischemia. The role of SCAD in acute coronary syndrome (ACS), and sudden death has come to light more and more, particularly in young females and those with few typical atherosclerotic risk factors. This study details a 65-year-old female with a history of hypertension, hyperlipidemia, asthma, and chronic kidney disease who presented with severe chest pain and elevated troponin levels. Upon investigation, spontaneous dissection of the left anterior descending artery (LAD) involving its mid and distal segments was identified. The present case highlights a rare occurrence of spontaneous coronary artery dissection (SCAD) in a demographic typically unaffected by the condition - females aged 65 years and over. The atypical presentation underscores the importance of reporting such cases to prevent oversight. This patient's case is particularly noteworthy as it deviates from the typical predisposing factors associated with SCAD, such as youth, pregnancy, or stressors. Additionally, the case is unique in that it presented both SCAD and imaging findings consistent with takotsubo cardiomyopathy, suggesting a complex cardiac pathology deserving of further study and consideration.

Apical Hypertrophic Cardiomyopathy Presenting With Syncope in a Hispanic Woman: A Report of a Rare Case.

Yamaguchi syndrome or apical hypertrophic cardiomyopathy is a rare subtype of non-obstructive hypertrophic cardiomyopathy that is defined as the focused hypertrophy of the left ventricular apex. It is typically seen in Asian populations. Herein, we present a rare case of Yamaguchi syndrome seen in a Hispanic female.

Salmonella Group B Ileitis Mimicking Crohn's Disease: A Case Report.

Salmonellae, considered among the enteric-fever-causing pathogens, is associated with a range of human infections, including gastroenteritis, bacteremia, and osteomyelitis. Salmonella-induced mesenteric adenitis and terminal ileitis resembling acute appendicitis have been reported in the literature. Here, we present a rare case of a patient presenting with severe acute active ileitis and colitis mimicking Crohn's disease with no prior history of inflammatory bowel disease and found to have Salmonella group B bacteremia.

Trends and Disparities in Valvular Heart Disease Mortality in the United States From 1999 to 2020.

BACKGROUND: Percutaneous heart valve procedures have been increasingly performed over the past decade, yet real-world mortality data on valvular heart disease (VHD) in the United States remain limited. METHODS AND RESULTS: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients ≥15 years old from 1999 to 2020. VHD and its subtypes were listed as the underlying cause of death. We calculated age-adjusted mortality rate (AAMR) per 100 000 individuals and determined overall trends by estimating the average annual percent change using the Joinpoint regression program. Subgroup analyses were performed based on demographic and geographic factors. In the 22-year study, there were 446 096 VHD deaths, accounting for 0.80% of all-cause mortality (56 014 102 people) and 2.38% of the total cardiovascular mortality (18 759 451 people). Aortic stenosis recorded the highest mortality of VHD-related death in both male (109 529, 61.74%) and female (166 930, 62.13%) populations. The AAMR of VHD has declined from 8.4 (95% CI, 8.2-8.5) to 6.6 (95% CI, 6.5-6.7) per 100 000 population. Similar decreasing AAMR trends were also seen for the VHD subtypes. Men recorded higher AAMR for aortic stenosis and aortic regurgitation, whereas women had higher AAMR for mitral stenosis and mitral regurgitation. Mitral regurgitation had the highest change in average annual percent change in AAMR. CONCLUSIONS: The mortality rate of VHD among the US population has declined over the past 2 decades. This highlights the likely efficacy of increasing surveillance and advancement in the management of VHD, resulting in improved outcomes.

Impact of Sarcoidosis on In-hospital Outcomes Among Patients with Atrial Fibrillation: A Nationwide Readmissions Database Analysis.

Sarcoidosis is a disease that involves multiple organs, including the cardiovascular system. While cardiac sarcoidosis has been increasingly recognized, the impact of sarcoidosis on atrial fibrillation (AF) is not well established. This study aimed to analyze the impact of sarcoidosis on in-hospital outcomes among patients who were admitted for a primary diagnosis of AF. Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged ≥18 years who were admitted for AF between 2017-2020. We stratified the cohort into two groups depending on the presence of sarcoidosis diagnosis. The in-hospital outcomes were assessed between the two groups via propensity score analysis. A total of 1031 (0.27%) AF patients with sarcoidosis and 387,380 (99.73%) AF patients without sarcoidosis were identified in our analysis. Our propensity score analysis of 1031 (50%) patients with AF and sarcoidosis and 1031 (50%) patients with AF but without sarcoidosis revealed comparable outcomes in early mortality (1.55% vs. 1.55%, P = 1.000), prolonged hospital stay (9.51% vs. 9.70%, P = .874), non-home discharge (7.95% vs. 9.89%, P = .108), and 30-day readmission (13.29% vs. 13.69%, P = .797) between the two groups. The cumulative cost of hospitalization was also similar in both groups ($12,632.25 vs. $12,532.63, P = .839). The in-hospital adverse event rates were comparable in both groups. Sarcoidosis is not a risk factor for poorer in-hospital outcomes following AF admission. These findings provide valuable insights into the effectiveness of the current guideline for AF management in patients with concomitant sarcoidosis and AF.

Systemic lupus erythematous associated with multi-vessel spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), often associated with atherosclerosis. However, SCAD has been increasingly recognized as a distinct entity, especially in young females without traditional cardiovascular risk factors. We present a case of a 56-year-old female with systemic lupus erythematosus (SLE) who developed multivessel SCAD involving the right coronary artery (RCA) and ramus. The patient's clinical presentation included typical chest pain, elevated troponins, and ST depressions on electrocardiography. Coronary angiography confirmed the presence of SCAD, classified as type 4 in the RCA and type 2 in the ramus. Prompt diagnosis and treatment resulted in a favorable prognosis. This case emphasizes the importance of considering SCAD in SLE patients presenting with ACS symptoms, particularly in younger women without evident cardiovascular risk factors. Early invasive coronary angiography is recommended for accurate diagnosis and timely management. SCAD can lead to significant complications and requires meticulous attention during angiographic procedures. Conservative management is often preferred, as most uncomplicated cases of SCAD heal spontaneously. Further research is needed to determine optimal treatment strategies and long-term outcomes for patients with SCAD, especially in the presence of underlying inflammatory conditions like SLE.

A Rare Case of Fulminant Myocarditis Caused by COVID-19 and Influenza B Co-infection.

Coronavirus disease 2019 and influenza B can have similar presentations and are self-limited in most cases. They are rarely associated with fatal cardiovascular complications. Coronavirus and influenza B-induced myocarditis is a rare but reversible cause of cardiogenic shock. Early detection plus administration of antiviral agents and supportive care with mechanical circulatory support in the form of an intra-aortic balloon pump can be a lifesaving measure in myocarditis.

Electrocardiographic abnormalities in patients presenting with intracranial parenchymal haemorrhage.

OBJECTIVES: The electrocardiographic abnormalities associated with ischaemic stroke and subarachnoid haemorrhage have been described frequently and studied systematically; however, these changes were not investigated thoroughly in patients with intracranial parenchymal haemorrhage (IPH). METHODS: We retrospectively reviewed the electrocardiograms (ECGs) and medical records of all patients who had been diagnosed with acute intraparynchemal haemorrhage (IPH) between 2006 and 2009. RESULTS: We included 160 patients (56% males). The median age was 71 years (interquartile range (IQR) 59 to 80) and 69% were above the age of 60 years. Most patients were hypertensive (81%).The majority of patients (86%) had at least one ECG abnormality. Sixty-eight (43%) patients had T-wave inversion and 65 (41%) had QTc interval prolongation. There was a significant association between QTc prolongation and the bleeding size and the presence of midline shift; odd ratios were 2.8 (CI 1.4 to 5.5; P 0.003) and 2.2 (CI 1.1 to 4.2; P 0.04), respectively. In addition, sinus tachycardia was found to be significantly associated with the presence of hydrocephalus (OR 4.1; CI 1.3 to 12.8; P 0.02). CONCLUSIONS: ECG abnormalities are a common finding in patients with IPH. Repolarizaion abnormalities occur the most frequently. QTc prolongation was associated with bleeding size and midline shift. Patients who had hydrocephalus were more likely to have sinus tachycardia at presentation.

Incidental Finding of an Asymptomatic Aortic Dissection in a Patient With Catheterization Failure.

Aortic dissection (AD) is an injury to the innermost layer of the aorta, leading to the formation of a false lumen. AD usually presents with tearing chest pain radiating to the back and is a medical emergency. Other common symptoms include abdominal pain, diaphoresis, loss of consciousness, shortness of breath, stroke-like symptoms, or leg pain. Here, we present a rare case of an incidental finding of asymptomatic AD on computed tomography angiography performed after cardiac catheterization failure. The patient had a history of aortic aneurysm, hypertension, and heart failure. Appropriate imaging should be performed to rule out the possibility of AD in patients with risk factors and cardiac catheterization failure.

A rare case of marijuana associated with ascending aorta thrombosis complicated with stroke and bilateral renal infarcts.

Ascending aortic is an uncommon site for arterial thrombosis and ascending aortic thrombosis is a very rare phenomenon with a high fatality rate. Marijuana is the most commonly used psychoactive drug in the United States and a few cases have been reported on the association of marijuana with vascular thromboembolism. However, the pathophysiology and exact mechanism are still not well studied. Herein, we present a case of a 44-year-old female with active marijuana use presented with ascending aortic thrombus associated with acute arterial occlusion of the right vertebral artery and bilateral renal artery. The unique part of this case is that the patient did not have the classical risk factors for vascular thromboembolic disease. The only risk factor was marijuana smoking. To our best knowledge, this is one of the unique cases of marijuana-associated with ascending aorta thrombosis.

Unusual Finding of Type 1 and Type 2 Spontaneous Coronary Artery Dissection in a Multiparous Female: A Case Report.

Spontaneous coronary artery dissection (SCAD) is an uncommon disease which can lead to acute coronary syndrome especially in young females. The risk factors associated with SCAD include connective tissue disorder, atherosclerosis, hormonal disturbances, history of physical and emotional stressors. Based on angiographic assessment SCAD is divided into three types. We present a unique case of multiparous female with concomitant type 1 and type 2 angiographic features of SCAD. The patient was started on medical therapy with close follow-up. This case highlights the importance of physician awareness about the occurrence of this rare cardiac condition in a young female without any significant risk factors.

Incidental finding of a right ventricular mass: Fibroma or thrombosis?

Primary cardiac tumors are very rare and are often confused with other conditions due to clinical presentations or initial imaging. Here, we present a rare case of a 56-year-old male with right ventricular mass incidentally found on imaging. Appropriate testing should be conducted to rule out the possibility of a benign tumor. Asymptomatic patients with co-morbidities can be managed without surgery. More research is needed to devise guidelines for the management of these cases.

The Role of Transcatheter Aortic Valve Replacement in Asymptomatic Aortic Stenosis: A Feasibility Analysis.

Surgical aortic valve replacement (SAVR) is the current treatment of choice for good surgical candidates with moderate to severe symptomatic aortic stenosis (AS). As transcatheter aortic valvular replacement (TAVR) has shown an improved one and two-year all-cause mortality, it has been chosen for moderately symptomatic severe AS patients. The purpose of this review was to perform a clinical comparison of TAVR vs. SAVR and to analyze the Health Index Factor (HIF) that makes TAVR a treatment of choice in asymptomatic AS patients.  An extensive literature search of PubMed, Cochrane, and Embase databases was performed using the keywords "Aortic stenosis", "SAVR", "TAVR", and "Asymptomatic". A total of 45 prospective randomized clinical trials in the English language that were published from the year 2000 onwards were included in the final analysis. It has been found that 59.3% of asymptomatic AS patients are likely to die in the next five years without proactive treatment. Multiple studies have proven that early intervention with aortic valve replacement is superior to conservative treatment in severe asymptomatic AS; however, the choice between SAVR and TAVR is not well established. The NOTION Trial, SURTAVI Trail, and PARTNER 3 study have shown the non-inferiority of TAVR over SAVR, during one-year follow-up for low surgical risk patients. Evolut Low-Risk study and Early TAVR are the only two prospective studies performed to date that have enrolled patients with asymptomatic severe AS. The Evolut Trial demonstrated no difference in all-cause mortality at 30 days (1.3% vs. 4.8%. p=0.23), and 12 days (1.3% vs. 6.5%, p=0.11). Additionally, TAVR also decreases the risk of post-procedural atrial fibrillation, acute kidney injury (AKI), and rehospitalization, and leads to significant improvement in the mean trans-aortic pressure gradient. TAVR also showed marked improvement in the 30-day Quality of Life (QOL) index, where SAVR did not report any significant change in the QOL index. However, the official recommendations of Early TAVR are still awaited. TAVR has consistently shown a statistically non-significant difference in case mortality, risk of stroke, and rehospitalization with moderate to high surgical risk patients whereby recent initial trials have shown significant improvement in the QOL index and hemodynamic index for patients with asymptomatic disease. More extensive studies are required to prove the risk stratifications, long-term outcomes, and clinical characteristics that would make TAVR a preferred intervention in asymptomatic patients.

A Rare Case of Isolated, Spontaneous, and Asymptomatic Common Carotid Artery Dissection.

Carotid artery dissection begins as a tear in one of the carotid arteries of the neck, which allows blood under arterial pressure to enter the wall of the artery and split its layers. The result is either an intramural hematoma or an aneurysmal dilatation. It is a significant cause of neurological signs and symptoms in all age groups. The common carotid artery dissection is the least affected and reported in the literature. There are multiple conditions that can cause the common carotid artery dissection including, trauma, procedures, and rarely spontaneous. Herein, we report a very unique and rare case of a female who presented with spontaneous and isolated common carotid artery dissection with no neurological signs and symptoms.

Marantic Endocarditis Associated with COVID-19: A Rare Case Report of a Potentially Deadly Disease.

Coronavirus disease 2019 (COVID-19) has overwhelmed healthcare globally with millions of cases and over 2 million deaths worldwide. The hypercoagulable state associated with COVID-19 is a well-recognized complication that carries a poor prognosis. Marantic endocarditis, or non-bacterial thrombotic endocarditis (NBTE), is caused by a sterile vegetation on the cardiac valves resulting from the deposition of fibrin and platelet aggregates. It is highly associated with the hypercoagulable and acquired inflammatory states. Herein, we report a unique and rare case of COVID-19 presenting with NBTE. LEARNING POINTS: COVID-19 has caused a major global pandemic, with high morbidity and mortality.One of the complications of COVID-19 infection is a hypercoagulable state.To the best of our knowledge, we present only the second case of marantic endocarditis in a patient with COVID-19, in the hope of raising awareness among physicians of this potential rare association.