Balloon assisted hematoma fenestration in spontaneous coronary artery dissection. Case presentation and literature review.

The management of spontaneous coronary artery dissection (SCAD) is lacking randomized data. This also holds for SCAD with ST-segment elevation myocardial infarction where stenting has been used to restore coronary flow. This approach can be associated with many drawbacks. Therefore, we present an alternative approach to stenting when coronary flow cannot be restored using cutting balloons alone.

Rare case of right ventricular dilatation associated with anomalous pulmonary venous drainage, sinus venosus atrial septal defect and persistent left superior vena cava.

A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to 'think horses and not zebras', and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.

UNEXPECTED SUDDEN DEATH IN A YOUNG MAN WITH MYOPERICARDITIS--A CASE REPORT.

A 31 years man was referred by general practitioner (GP) with chest pain preceded by sore throat a week ago. Electrocardiogram was suggestive of pericarditis and Troponin and inflammatory markers were elevated. Echocardiogram showed small pericardial effusion with normal biventricular size and function, and no regional wall motion abnormalities (RWMA). A clinical diagnosis of myopericarditis was made. Patient was in good clinical condition so he self-discharged before cardiac MRI. Two days later he died of cardiac arrest. His post mortem confirmed the diagnosis of myopericarditis. He died despite of absence of known poor prognostic features of Myopericarditis.

Radiation dose during coronary angiogram: relation to body mass index.

OBJECTIVE: Ionising radiation based diagnostic and therapeutic cardiology and radiology procedures are very common in present day medical practice and are one of the largest medical sources of radiation to humans. The risk to health from radiation has been extensively documented. Obesity is becoming epidemic not only in the western world, but also in developing countries. In the present study we investigated if a patient's Body Mass Index (BMI) has an effect on the radiation dose received by the patient and operator during diagnostic coronary angiography (CAG). METHODS: We analysed data of 3678 consecutive patients who underwent CAG from September 2007 to April 2010 in our cardiac catheter laboratory. Trans-radial access was used in 622 patients, whereas 3056 patients underwent CAG through trans-femoral route. We calculated the radiation dose in dose area product (DAP) units and correlated it with body mass index, screening time, procedure time, contrast volume, vascular access route and individual operator. RESULTS: Among the explored parameters, body mass index had the most significant association with the radiation dose during the procedure. Despite having similar procedure times and contrast doses, patients with increased BMI received much higher radiation dose during CAG. We also found the left anterior oblique (LAO) caudal and LAO cranial views produced the biggest increase in radiation dose in patients with a high BMI. There was no inter-operator variability. CONCLUSION: Obese patients require more than double the radiation dose in comparison to those with normal BMI. The operator should be aware of the increased dose of radiation required when performing CAG in patients with increased BMI, and especially in LAO cranial and caudal views.

Pulmonary embolism presenting as non-ST elevation myocardial infarction: a case report.

We describe a case which highlights the difficulties in diagnosing pulmonary embolism as it can mimic other conditions. In a patient with chest pain with raised troponin, a diagnosis of pulmonary embolism should also be considered as well if the clinical picture does not fit with myocardial infarction. Otherwise, the diagnosis of pulmonary embolism can be easily missed and patients may not receive appropriate treatment resulting in increased mortality.