The Missing Coronary: A Case Series of Inferior Wall Myocardial Infarction Due to Coronary Anomalies.

Coronary artery anomalies, while often asymptomatic, can sometimes present acutely in the context of myocardial infarction (MI). This case series highlights three unique instances of inferior wall MI precipitated by rare coronary anomalies. The first case involved a 40-year-old male with a congenital absence of the left circumflex artery, presenting with a "shark fin" ECG pattern in inferior leads. Urgent coronary angiography confirmed the anomaly and primary percutaneous coronary intervention (PCI) was performed on a superdominant right coronary artery (RCA). The second case details a 52-year-old male with a split RCA, initially undiagnosed due to apparently normal angiographic findings, later revealed to have a thrombotic occlusion of the posterior division. Careful re-evaluation and imaging from alternative angles facilitated successful PCI. The third case describes a 45-year-old male with an anomalous origin of the RCA from the left sinus of Valsalva, presenting difficulties during arterial engagement in PCI. A modified Judkins left catheter technique was employed to achieve selective cannulation and stent deployment. These cases underscore the importance of early recognition, accurate diagnosis, and innovative interventional strategies in managing acute MI due to congenital coronary anomalies.

Diligence diverts a daymare.

A 73-year-old woman with diabetes, hypertension, and non-ST elevation myocardial infarction underwent optical coherence tomography (OCT)-guided angioplasty for calcific stenosis of the mid-left anterior descending artery (LAD) and mid-segment of a tortuous obtuse marginal (OM).

Feud, Flower, and Fatal Electrocardiograms.

Oleander is a prevalent tropical plant used in many parts of India for deliberate self-harm. The active ingredients act in a mechanism similar to cardiac glycosides; hence, the toxicological profile is similar to digoxin toxicity. Cardiac toxicity occurs in the form of a heart block with concomitant ventricular arrhythmia. Identifying the distinct electrocardiographic pattern for early diagnosis and initiating emergency management is imperative. Here, we present two such interesting cases of oleander intoxication, one with Nerium oleander and the other with Thevetia peruviana.

'Size it and fix it': pulsatile abdomen and presyncope post pacemaker implantation.

A 69-year-old obese man who had undergone permanent pacemaker implantation (VVIR, Medtronic) 3 weeks prior presented with a one-day history of experiencing continued, forceful pulsations in his abdomen followed by presyncope.

Never fail to surveil! Transcatheter closure of recurrent atrial septal defect secondary to patch degradation in a young boy.

We report a case of a 16-year-old boy with symptomatic recurrent atrial septal defect due to patch degradation of an autologous pericardial patch, done 10 years back. He successfully underwent transcatheter closure of the recurrent defect after meticulous assessment of patch rims for stability.

Wandering ST-Segment in Acute Coronary Syndrome: The Einthoven's Twist.

Interpretation of the ST-segment axis in ST-elevation myocardial infarction (STEMI) plays a crucial role in identifying the culprit artery and optimizing revascularization strategies. In certain conditions, the ST-segment axis may abruptly change during management, creating diagnostic confusion, provoking unnecessary workups, and causing treatment delays. Some reported causes of wandering ST-segment include lead misplacement, progressive injury, coronary vasospasm, migration of the thrombus, and aortic dissection. Here we describe two exciting cases of wandering ST-segment axis in acute coronary syndrome and its management.

No Room for Excess Room: Cobra Head Deformity of Both Discs of an Amplatzer Atrial Septal Occluder Device.

To our knowledge, this is the first case in the literature citing cobra head deformity of both atrial discs. A large delivery sheath with excess room possibly led to deformity in our case. This case highlights the importance of following manufacturer- recommended sheath sizes for optimal device implantation.

Challenging Case of Balloon Mitral Valvuloplasty: Coronary Balloon to the Rescue.

Owing to the demonstrated safety and cost-effectiveness, balloon mitral valvuloplasty is frequently performed using reused hardware. However, chances of hardware malfunction are higher in such settings, making it pertinent for operators to be adept at recognition and management of such complications. This case illustrates that when the rent is small, a coronary balloon may be used to tackle the inflation failure.