ABSTRACT
Coronary artery fistulas (CAFs) are rare vascular anomalies characterized by abnormal connections between coronary arteries and cardiac chambers or adjacent structures. Advances in cardiac interventions have led to an increasing recognition of acquired CAFs, which are typically congenital. We present a case of a 62-year-old male with a complex medical history, including hypertension, atrial fibrillation, and heart failure, who presented with exertional chest pain and palpitations. Diagnostic evaluation revealed a significant CAF originating from the right coronary artery (RCA) and terminating into the coronary sinus and right ventricle. Despite the absence of significant coronary artery occlusions, the fistula was deemed clinically significant due to its potential to cause myocardial ischemia. Management involved guideline-directed medical therapy and lifestyle modifications. This case underscores the importance of early recognition and appropriate management of CAFs to optimize patient outcomes. Further research is needed to better understand the natural history and optimal management strategies of CAFs.
ABSTRACT
Mitral annular calcification (MAC) is relatively common in clinical practice. Females are more often affected than males. Patients with end-stage renal disease have MAC relatively more commonly than the general population. Patients with MAC often develop conduction system disturbances, including advanced atrioventricular blocks. They are also more likely to develop various arrhythmias, including atrial fibrillation. Caseous mitral annulus calcification is a variant of MAC that often looks like a cardiac tumor on an echocardiogram and needs to be differentiated.
ABSTRACT
Antiphospholipid syndrome (APLS) and systemic lupus erythematosus (SLE) are rare autoimmune disorders that afflict a small percentage of the global female population. The complexity of these conditions is further exacerbated by their propensity to give rise to recurrent thrombosis and obstetric morbidity, thereby posing intricate challenges for clinicians and patients alike. One of the most concerning aspects of these diseases is the heightened risk they confer for accelerated atherosclerosis, which can ultimately culminate in the development of acute coronary syndrome (ACS). This case report describes a 27-year-old female with APLS, SLE, and lupus nephritis. She suffered from a catastrophic antiphospholipid syndrome (CAPS) episode and simultaneously developed ACS. She also had a patent foramen ovale (PFO) shunt.
ABSTRACT
Atrial fibrillation (AF), a cardiac arrhythmia, exhibits a heightened prevalence among individuals diagnosed with cancer, notably prominent in cases of lung and gastrointestinal malignancies. Robust evidence from extensive studies underscores this association, emphasizing its clinical significance. However, the precise mechanistic underpinnings and specific risk factors linking cancer and AF remain a subject of incomplete understanding. Notably, the prevalence of AF in cancer patients substantially exceeds that in non-cancer counterparts, prompting further exploration of the underlying pathophysiological processes. This review aims to address the existing knowledge void regarding AF management in cancer patients, with a specific focus on the potential role of ablation procedures. While catheter and surgical ablation techniques have been thoroughly investigated and validated as effective treatments within non-cancer populations, their applicability and outcomes in cancer patients have remained inadequately explored. The principal objective of this exhaustive review is to bridge this research gap by conducting a meticulous examination of the feasibility, safety, and effectiveness of ablation interventions for AF in the context of cancer patients. By amalgamating existing evidence and pinpointing critical areas necessitating additional investigation, this review endeavors to provide invaluable insights into AF management in cancer patients, with the ultimate goal of enhancing their clinical care and optimizing outcomes.
ABSTRACT
Coronavirus disease 2019 (COVID-19) burden has been identified to cause multiorgan damage. Respiratory compromise is still one of the most common presentations, but cardiac injuries like myocardial injury, ischemia, and conduction abnormalities are also becoming prevalent. We present a case of an 87-year-old male with a history of dementia, type 2 diabetes mellitus, hypertension, chronic kidney disease, and a left kidney transplant hospitalized for respiratory distress and generalized tonic-clonic seizures. He was bradycardic to 27 beats per minute, hypotensive with mean arterial pressure <60 mm Hg. An electrocardiogram (EKG) depicted a high-grade atrioventricular block (AV-block). The transvenous pacemaker was placed via femoral access and tested positive for COVID-19. Work-up was done to rule out possible causes of bradycardia, like hypothyroidism, ischemia, AV nodal blocking agents, and drug-induced bradycardia was negative. His hospital stay got complicated by methicillin-resistant staphylococcus aureus (MRSA) pneumonia leading to empyema and bacteremia. Unfortunately, being critically ill, the family opted for comfort measures, and he passed away. Our clinical vignette signifies cardiovascular complications in COVID-19 patients are associated with poor outcomes if not addressed. The conduction abnormalities in patients with intact cardiac structure and function are becoming more common in the setting of COVID infection. Assessment with serial EKGs and cardiac monitoring might be essential as patients can develop AV blocks at any point of the disease.
