ABSTRACT
Spontaneous coronary artery dissection (SCAD) is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, which has gained considerable recognition as an important cause of acute coronary syndrome. Despite the emerging evidence, it is still frequently missed and requires a high index of suspicion, as failure to accurately identify SCAD promptly could prove fatal. SCAD is most prevalent among middle-aged women, although it can also be found in men and postmenopausal women. Risk factors of SCAD include exogenous hormone use, physical and emotional stressors, pregnancy, and several inflammatory and connective tissue disorders. COVID-19 also contributes to the prevalence of SCAD. SCAD is classified into four main types based on the angiographic findings - type 1, type 2, type 3, and type 4. The gold standard for diagnosis is coronary angiography; however, intracardiac imaging is useful if diagnostic doubts persist. Despite the increasing recognition of this disease, there is a paucity in the guidelines on the management of SCAD. Management may be conservative, medical, or interventional. Cardiac rehabilitation is also necessary in the management of patients with SCAD. In light of the gaps in evidence, the authors aim to provide a comprehensive review of the existing literature, outlining the pathophysiology, classification, and, most importantly, the evidence and pitfalls circulating diagnosis, acute, and long-term management of SCAD.
ABSTRACT
Hyperthyroidism is an endocrine disorder characterized by excess thyroid hormone production. Its classic symptoms include weight loss, palpitations, tremors, and anxiety. We present a case of a 33-year-old female who initially presented with anxiety-like symptoms, leading to a misdiagnosis of generalized anxiety disorder. Upon further evaluation, the patient was diagnosed with hyperthyroidism, highlighting the importance of evaluating endocrine causes in patients presenting with anxiety-like symptoms. This case report underscores the significance of a comprehensive medical evaluation in patients with anxiety to avoid misdiagnoses and ensure appropriate management.
ABSTRACT
Vancomycin is a widely used tricyclic glycopeptide antibiotic for treating various Gram-positive infections, including Clostridium difficile colitis. Although considered generally safe, it has been associated with several side effects. In this case report, we highlight a rare adverse effect in which a patient experienced chronic photophobia following treatment with oral vancomycin. This sheds light upon a potential relationship between oral vancomycin therapy and photophobia, emphasizing the need for increased awareness in clinical practice and urging further investigation into this association.
ABSTRACT
Spontaneous coronary artery dissection continues to pose a diagnostic dilemma in the evaluation of patients with chest pain. Our case discusses its manifestation in a male patient who visited the emergency department complaining of recent-onset chest pain. Evaluation of his chest pain through coronary angiography revealed luminal radiolucency corresponding to type 1 spontaneous coronary artery dissection (SCAD). The patient was promptly managed using medical interventions until stability was achieved and referred to cardiac rehabilitation care with close follow-up. In our literary contribution, we present a fascinating diagnosis, potentially life-threatening, observed in an otherwise active and healthy male patient. Notably, this diagnosis is uncommon in the male population. Through this study, we aimed to shed light on understanding, awareness, and clinical recognition of SCAD, ultimately improving patient care and outcomes.
ABSTRACT
Pancreatic pseudocyst is a common complication of pancreatitis and is usually located in the peripancreatic space, spleen, and retroperitoneum. An infected intrahepatic pseudocyst following acute on chronic pancreatitis is extremely rare. Here, we report a case of intrahepatic pancreatic pseudocyst with superimposed infection following chronic pancreatitis in a 42-year-old female who presented with severe abdominal pain, vomiting, and bloating sensation. Her labs showed elevated pancreatic enzymes (amylase and lipase), and a provisional diagnosis of acute pancreatitis was made. Imaging revealed a cystic lesion in the left lobe and a calcified pancreas. Endoscopic aspiration of the cystic lesion and pathologic examination confirmed infected intrahepatic pancreatic pseudocyst due to the high serum amylase level and positive Enterococci on culture in aspirated cystic fluid, complicated by chronic pancreatitis.
