Large Right Atrial Myxoma Presenting As Bilateral Pulmonary Embolism.

Myxoma is a rare benign tumor of the heart. Cardiac myxomas are the most common primary cardiac tumor in adults, commonly found within the left atrium. It can occur at any age and is more common in females than males. This case report aims to identify the clinical symptoms of cardiac myxoma, which can be life-threatening if neglected. Here, we present the case of a 30-year-old female with past smoking history. For the past three to four weeks before this hospitalization, her symptoms worsened including shortness of breath with exertion, dry cough, and pleuritic chest pain. Outpatient treatment with antibiotics and nebulizers did not relieve her symptoms. She went to the emergency room and underwent computed tomography of the chest with contrast showing bilateral lower lobe pulmonary emboli and a large mass in the right atrium. Intravenous unfractionated heparin was initiated. A transthoracic echocardiogram confirmed a 3.76 cm × 4.95 cm mass in the right atrium. The patient underwent surgical resection of the right atrial mass the following day and was discharged four days later in a stable condition. Pathology of the mass confirmed atrial myxoma.

Complete Dissection of the Interventricular Septum Following Myocardial Infarction.

In this report, we present a case of interventricular septal dissection (IVSD) following inferior wall myocardial infarction (MI) in a 64-year-old patient; the patient ultimately recovered after prompt resuscitation and intervention, despite the high mortality associated with these cases. A 64-year-old male with a history of hypertension and obesity was brought to the hospital following an episode of syncope at home. He had been experiencing chest tightness over the past few days prior to the admission. On physical exam, he had a heart rate of 72 beats per minute and blood pressure of 73/52 mmHg. His electrocardiogram revealed ST-segment elevations in leads II, III, and aVF. Emergent coronary angiography revealed 100% occlusion of the right coronary artery (RCA) with no collateral supply and 95% stenosis of the left anterior descending (LAD) artery. Aspiration thrombectomy and balloon angioplasty and subsequent stenting of the RCA were performed. Transthoracic echocardiogram with color Doppler was performed, which confirmed the presence of a defect in the septum. Color Doppler demonstrated a clear jet entering the ventricular septum from the left ventricle (LV), with the jet traversing the entire length of the septum through a dissection and entering into the right ventricle (RV), consistent with complete IVSD. The patient subsequently underwent a successful bovine pericardial patch repair of the ventricular septum. IVSD is a rare anomaly of the IVS. An echocardiogram is a useful tool to establish the diagnosis. The mortality rate after ventricular septal rupture remains high. Fortunately, our patient had interventricular dissection without rupture. Prompt surgical repair remains the choice of treatment for this condition.

Successful Percutaneous Balloon Angioplasty in a Patient Presenting With STEMI and Acute Intracranial Hemorrhage.

Percutaneous coronary interventions (PCI) mandates the administration of anti-platelet and anti-thrombotic agents to prevent intracoronary and post-procedural thrombosis upon introducing thrombogenic foreign bodies such as intracoronary wires, balloons, or stents, especially in the setting of acute coronary syndrome (ACS) given the hypercoagulable state associated with it. This is a case of a 54-year-old female who presented to the emergency department with left-sided weakness and dysarthria for an unknown duration. A CT scan of the head showed acute right middle cerebral artery distribution infarct. She subsequently underwent a successful thrombectomy. Four hours later, the patient became lethargic and nauseous. Electrocardiogram showed anterior wall ST elevation with new-onset anterior wall akinesia on transthoracic echocardiogram. Repeat CT of the head showed acute intracranial hemorrhagic conversion. She then developed cardiac arrest mandating emergent cardiac catheterization. Coronary angiogram revealed 100% occlusion in a mid left anterior descending artery (LAD) and 80% in a left circumflex artery (LCX) and chronic total occlusion of the right coronary artery (RCA). After weighing risks and benefits, PCI was performed with rapid plain old balloon angioplasty (POBA) to the 100% thrombotic lesion in the LAD with successful restoration of flow without administering anti-platelet or anti-thrombotic agents given the acute intracranial hemorrhage, She was then discharged to a rehab facility a few days later in stable condition. This case demonstrates successful percutaneous coronary intervention in the 100% occluded LAD in a life-threatening situation despite not using anticoagulation or antiplatelet therapy due to active intracranial hemorrhage.

Pulmonary Embolism in COVID-19 Treated with VA-ECLS and Catheter tPA.

BACKGROUND: Novel coronavirus 2019 (COVID-19) has been the focus of the medical world since being declared a pandemic in March 2020. While the pathogenesis and heterogeneity of COVID-19 manifestations is still not fully understood, viral evasion of cellular immune responses and inflammatory dysregulation are believed to play essential roles in disease progression and severity. CASE PRESENTATION: We present the first case of a patient with COVID-19 with massive pulmonary embolism treated successfully with systemic thrombolysis, VA-ECLS, and bail out catheter directed thrombolysis. He was discharged from the hospital after an eventful hospital course on therapeutic anticoagulation with warfarin. CONCLUSIONS: We present the first case of a patient with COVID-19 with massive pulmonary embolism (PE) treated successfully with systemic thrombolysis, VA-ECLS and bail out catheter directed thrombolysis. In our experience catheter directed thrombolysis comes with an acceptable bleeding risk despite use of mechanical circulatory support, particularly with meticulous attention to vascular access and dose response monitoring.

Aggressive Staphylococcus lugdunensis Endocarditis in a Young Healthy Patient: A Case Report.

Staphylococcus lugdunensis (S. lugdunensis) is a ß-hemolytic coagulase-negative staphylococcus causing skin and soft tissue infections with an increasing incidence. Commonly found as normal flora in the perineal region, S. lugdunensis has been found in rare cases of infective endocarditis causing increased morbidity and mortality. We present a case of a previously healthy young male diagnosed with S. lugdunensis-caused infective endocarditis. A 31-year-old male with no significant past medical history, who presented to the emergency department with acute onset crushing substernal chest pressure and dyspnea with profuse sweating following 1-week-long febrile illness and malaise. The initial electrocardiogram (ECG) showed diffuse ST depressions in all precordial leads, consistent with an acute coronary syndrome. Emergent transthoracic echocardiogram revealed an ejection fraction (EF) of 45% with severe aortic insufficiency with emanating from a torn right coronary cusp. The patient had a cardiac arrest, and recovery of spontaneous circulation (ROSC) was obtained after 13 min. He subsequently underwent mechanical aortic valve replacement surgery. The native valve specimen cultures grew S. lugdunensis. Postoperatively and after a long course of antibiotics, the patient fully recovered without complications. S. lugdunensis is a common organism with increasing incidence that can lead to significant morbidity and mortality if not properly detected and treated. We hope this case presentation would support emergency valve replacement surgery in patients with S. lugdunensis-suspected infective endocarditis.