Recurrent Takotsubo Cardiomyopathy Secondary to Cyclical Vomiting Syndrome.

We present a case of a young woman having recurrent admissions secondary to cyclical vomiting syndrome complicated with stress-induced cardiomyopathy/takotsubo cardiomyopathy (TC). She not only had left ventricular dysfunction but also suffered from anxiety and post-traumatic stress disorder for which professional help was sought. TC is defined as reversible, transient ventricular dysfunction in the absence of coronary artery disease. Due to the similarity of TC to acute coronary syndrome, TC is often left as a diagnosis of exclusion as it relies heavily on diagnosis by history, physical examination, and ultrasound imaging. Extreme emotional or physical stress can act as a trigger and timely identification and management of triggers causing TC are important to improve the outcome. In addition to physiological impact, TC also puts a toll on psychological health. Although the mechanism is not completely understood, reportedly plasma levels of epinephrine and norepinephrine were significantly elevated in patients with TC which might contribute to depression, anxiety, and psychological distress. Along with proper medical care, psychological care is equally important for patients with TC.

Prevalence of lipoprotein(a) measurement in patients with or at risk of cardiovascular disease.

INTRODUCTION: Lipoprotein(a) [Lp(a)] is a genetically determined independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease. Despite recommendations from professional societies in the cardiovascular field, the awareness of elevated Lp(a) as a risk factor and screening for Lp(a) are suspected to be low. METHODS: We conducted a retrospective, observational case control study of patient charts from January 1, 2017 to June 19, 2022. The primary aims were 1) to describe the proportion of patients at the healthcare network's primary care and cardiology clinics that met Lp(a) screening criteria and were tested; and 2) to describe the proportion of patients throughout the entire healthcare network that had Lp(a) measured. RESULTS: Of the 2,412,020 patient charts in the health network, only 5,942 (0.25 %) had Lp(a) measured. Of the 84,581 patients in primary care or cardiology clinics who met screening criteria, only 1,311 (1.55 %) had Lp(a) measured. Patients with Lp(a) measured were more likely to be younger, non-Hispanic/Latinx, had a lipid panel measured, a cardiac computed tomography (CT) imaging study, and higher low-density lipoprotein-cholesterol. Patients with ASCVD, heart failure, ischemic heart disease, aortic stenosis, peripheral vascular disease, or a stroke did not feature highly among patients who received Lp(a) testing. Having an abnormal or risk-enhancing Lp(a) level was associated with being female and/or being Black/African American. CONCLUSIONS: Despite increased awareness of Lp(a) and its contribution to cardiovascular disease there exists a paucity of testing. Increased Lp(a) testing can identify patients who have an increased cardiovascular risk underestimated by other metrics.

Acute aortic dissection in the Marfan syndrome during the COVID-19 epidemic.

A 17-year-old boy with a recent diagnosis of COVID-19 infection was admitted with acute chest pain due to type A aortic dissection and was subsequently diagnosed with the Marfan syndrome. Literature shows an increased rate of aortic dissection during flu season. The hypothesis is that a cytokine storm triggers the dissection.