Delayed coronary perforation four days after percutaneous coronary intervention with subsequent cardiac tamponade: A case report.

Coronary artery perforation (CAP) is a rare but lethal complication of percutaneous coronary interventions (PCIs), and its incidence has been increasing with advances in PCI techniques. Delayed CAP presents a highly challenging complication, as it occurs 30 min-9 days after intervention, making subsequent diagnosis and treatment difficult. We present the case of a 63-year-old male patient who underwent PCI for an obtuse marginalis II because of posterior wall myocardial infarction. Following 4 days of uneventful postoperative stay, the patient developed angina pectoris and hypotension 4 h after reinitiation of anticoagulant therapy with edoxaban. Angiography revealed distal vessel perforation from a side branch of the obtuse marginalis II. The vessel was occluded using autologous fat embolization via a microcatheter, resulting in complete sealing of the perforation. After discharge, 4 weeks after the infarction, the patient started rehabilitation therapy. Distal vessel perforations are typically caused by wire damage. In our case, we also suspected distal wire perforation, which was initially not recognized possibly due to distal occlusion through the thrombotic material. The temporal correlation between the re-initiation of anticoagulant therapy and the occurrence of cardiac tamponade suggests that the thrombotic material was resolved due to the former. The management of delayed CAP does not differ from that of CAP; thus, this rare complication should be considered even days after PCI as it could prove lethal if not recognized early.

From inoperable to back to life: a case report of successfully treated obstructive right ventricular primary cardiac lymphoma.

BACKGROUND: Cardiac masses include various tumourous and non-tumourous lesions. Primary cardiac tumours are very rare and most commonly benign. Primary cardiac lymphomas (PCL) account for 1-2% of malignant primary cardiac tumours. Only 197 cases of PCL have been reported between 1949 and 2009. CASE SUMMARY: We report a case of a 73-year-old patient who presented with atrial flutter. The diagnosis was a tumourous cardiac mass in the right atrium with signs of the infiltration of the tricuspid valve insertion and pericardium. There were no signs of extracardiac disease at the initial presentation. The patient was deemed to be inoperable by cardiac surgeons. Rapid tumour progression caused atrioventricular-block type Mobitz 2 with concomitant obstruction of the tricuspid valve and axillary lymph node metastasizing. Excision of the axillary lymph node revealed a diffuse large B-cell non-Hodgkin lymphoma. An epicardial right ventricle single lead pacemaker was sited, and chemotherapy was administered, resulting in complete remission. DISCUSSION: Cardiac masses are rare and challenging cases. Although current imaging procedures deliver extensive information, histological examination is still required in many cases. We encountered a tumourous mass with deep infiltration. After the patient was deemed inoperable, later lymph node invasion allowed histological examination, revealing PCL. Primary cardiac lymphomas are life-threatening tumours with rapid and aggressive growth. Treatment is based on chemotherapy consisting of anthracycline-containing regimens. This case report highlights the curative potential of chemotherapy, as we report a rapid regression of the tumour as well as the disappearance of arrhythmias and conduction disorders after treatment.

[Troponin test in clinical daily practice - Differences in the quality criteria for the diagnosis of acute myocardial Infarction considering clinical leading symptoms: A cross-sectional study]. / Troponin-Test im Alltag ­ Unterschiede der Gütekriterien in der Diagnose des akuten Myokardinfarkts unter Berücksichtigung klinischer Leitsymptome: eine Querschnittsstudie.

INTRODUCTION: Cardiac troponins are the prefered cardial biomarker in the diagnosis of acute myocardial infarction. Because they are detectable by myocardial cell damage, no matter what pathophysiology, the interpretation of a positive test is difficult. The aim of this study is to assess the quality criteria of the troponin test in the diagnosis of acute myocardial infarction in everyday life and whether clinical leading symptoms have an influence on it. METHODS: This is a retrospective cross-sectional study, in which all patients who presented themselves in the emergency department of the Klinikum Lippe-Detmold between 01.01.2014 and 31.05.2014, and had a Troponin-I test were included. The diagnosis "acute myocardial infarction" referred to myocardial infarction type I and was made by the cardiologist on-duty. The patients were divided into four subgroups according to the leading symptoms. The quality criteria of the Troponin-test were calculated. RESULTS: 1046 patients were included. In 15 %, acute myocardial infarction was present, of which 97 % had thoracic pain. The sensitivities and the negative predictive values were over 90 %. The specificities ranged between 56 % and 81 %. The positive predictive values were modest and best in case of thoracic pain 58 %. CONCLUSION: The Troponin test had a good negative predictive value for all clinical symptoms. Thus, an acute myocardial infarction could be excluded with high precision. However, the positive predictive value was low. The only direct symptom that achieved acceptable levels was thoracic pain.