Takotsubo Cardiomyopathy Associated With Influenza A and a Ground-Level Fall.

Our case involves a 92-year-old female who presented to the emergency department due to a ground-level fall and difficulty breathing. She was found to have influenza A, elevated troponin, and decreased left ventricular ejection fraction. However, cardiac catheterization did not reveal any coronary artery stenosis, supporting a diagnosis of takotsubo cardiomyopathy (TC). The patient's ejection fraction was normal after nine months. This case highlights the importance of considering TC in elderly female patients who have reduced ejection fraction and elevated troponin in the setting of infection and a recent fall.

A Case of Saphenous Vein Graft Aneurysm Treated With Percutaneous Coiling.

In adults, coronary artery bypass grafting (CABG) is a commonly performed surgery. Oftentimes, saphenous veins from the lower extremity are used as the graft vessels. A rare complication of this procedure is the formation of saphenous vein graft (SVG) aneurysms. We present the case of a 63-year-old male who presented to a referring emergency department with left-sided chest pain after falling off a ladder. The patient's initial chest X-ray revealed a suprahilar mass that was suspicious for being an aneurysm. A computerized tomography coronary angiogram indicated a large aneurysm. The patient was transferred to our facility for specialist evaluation. The patient's history was positive for two CABG procedures and a sternal wound infection, so a repeat sternotomy was not advisable. The SVG aneurysm was treated with percutaneous coiling. The patient tolerated the procedure well and was discharged home the next day.

Global Pseudo-Atrial Flutter on Electrocardiogram and the Importance of Clinical Correlation.

Parkinson's disease is a condition in which tremors, rigidity, bradykinesia, difficulties with sleep, autonomic symptoms, and mood disturbances can be present. We present an intriguing case in which such tremors appear as a global pseudo-atrial flutter on electrocardiogram (ECG). A 73-year-old Caucasian female presented to the cardiology clinic for management of atrial flutter diagnosed by ECG in a primary care setting. In the cardiology clinic, the physical examination of the patient revealed bilateral upper extremity resting tremors. The ECG machine initially read the findings as "atrial flutter." However, immobilization of the patient's arms bilaterally resulted in a normal sinus rhythm. Repeated ECGs when the arms were relaxed and when the arms were immobilized resulted in findings consistent with pseudo-atrial flutter and normal sinus rhythm, respectively. Considering tremors as a source of artifact on electrocardiogram in patients with tremors and using corrective measures are critically important to prevent misdiagnosis, unnecessary testing, and potentially harmful treatments. This case underscores the importance of educating healthcare team members about tremor-induced artifacts in patients with tremors to avoid misdiagnosis based on ECG readings.