Marijuana Induced Pericarditis: An Emerging Crisis.

Background: The use of marijuana, derived from the Cannabis plant, has a lengthy history dating back thousands of years. With the recent legalization of marijuana in many US states, concerns about its health effects have grown. Despite traditional beliefs in its cardioprotective properties, there is a rising incidence of marijuana-induced pericarditis. This article presents a case that highlights the potential connection between marijuana use and cardiac complications. We herein present a case of a 30-year-old male with habitual marijuana use coming in with pericarditis. Case: A 30-year-old male, a habitual marijuana user, presented to the emergency department with recurrent chest pain and shortness of breath. Notably, similar episodes were resolved when he abstained from marijuana. Diagnostic findings upon admission included elevated inflammatory markers, EKG showing diffuse ST segment elevations and PR depressions, echocardiographic evidence of pericardial effusion and EKG consistent with pericarditis. After excluding other causes, marijuana was identified as the likely trigger for his cardiac symptoms. Decision making: NSAIDS and colchicine were started at therapeutic doses for the patient. Cardiology and Cardiothoracic Surgery were consulted. No drainage was planned as patient was clinically stable and improved with medical management alone. Conclusion: The emerging link between marijuana use and pericarditis presents a unique clinical challenge. Comprehensive population-based studies are needed to understand the cardiovascular implications of marijuana use and to develop appropriate management guidelines. Clinicians should approach marijuana use cautiously, considering potential cardiovascular risks, and remain vigilant for pericarditis as a potential consequence of marijuana use during patient evaluations.

Echocardiographic Features of an Evolving Periaortic Valvular Abscess in a Patient with Staphylococcus Epidermidis Prosthetic Valve Endocarditis.

Prosthetic valve endocarditis is a serious complication following valve replacement surgery, with the development of aortic root abscess being a catastrophic manifestation. We present a case of a 71-year-old female with a bioprosthetic aortic valve who presented with shortness of breath. Echocardiographic findings revealed vegetation on the prosthetic aortic valve with a periaortic, annular abscess. Given the patient's comorbidities and high surgical risk, conservative management with antibiotics was chosen. The patient responded well to antibiotic therapy and was discharged with long-term antibiotic treatment. Prosthetic valve endocarditis, particularly with periaortic abscess formation, is associated with significant morbidity and mortality. Early diagnosis and appropriate management are crucial for improving outcomes.

Contained Left Ventricular Free Wall Rupture Following a Silent Myocardial Infarction.

A left ventricular pseudoaneurysm (LVP) is defined as an outpouching contained by the surrounding pericardium. Clinical presentation is often unspecific with patients presenting with chest pain, dyspnea, symptoms consistent with heart failure, and post-myocardial infarction. Cardiac magnetic resonance imaging represents an important tool for differentiating a pseudoaneurysm from a true aneurysm. Furthermore, multiple imagining modalities are available, including transesophageal and transthoracic echocardiogram and contrast ventriculography, which remains the gold standard diagnostic technique. Early recognition and prompt surgical management are of utmost importance in patients with acute and symptomatic LVP. On the other hand, medical management may be considered in patients with chronic and small pseudoaneurysms. Here, we are presenting a 74-year-old lady who presented with chest pain and was found to have a chronic and small LVP which was managed conservatively.

Troponemia Secondary to Air Duster Inhalant Abuse.

The abuse of inhalants has become a public health concern in the USA over the past decade. Compressed air duster cans currently available in the USA contain highly toxic substances including different hydrofluorocarbons (including tetrafluoroethane and difluoroethane) which exert a psychoactive effect on the central nervous system. Several cases of inhalant-induced lethal arrhythmia such as ventricular fibrillation evolving to torsade de pointes and leading to cardiac arrest, have been reported in the literature. Furthermore, multiorgan failure including liver and kidney injury has been described after inhalant abuse. We report the case of a 33-year-old man found diaphoretic and with a near syncopal episode after inhalation of several cans of Surf Onn electronic duster gas cleaner, who subsequently developed acute cardiac, liver and kidney injury. LEARNING POINTS: Although the pathophysiological mechanisms have not been fully elucidated, the hydrofluorocarbons in air duster cans may exert a psychoactive effect through GABA receptor stimulation and NMDA receptor inhibition.Clinicians should maintain a low threshold of suspicion for patients presenting with multiorgan failure, predominantly cardiac arrhythmias after inhalant overdose.Prompt recognition and early intervention are imperative for preventing fatal outcomes such as cardiac arrest secondary to life-threatening cardiac arrhythmias.

A Rare Case of Embolic ST-Elevation Myocardial Infarction in an Adult Patient With Repaired Hypoplastic Left Heart Syndrome.

A 24-year-old male with past medical history of hypoplastic left heart syndrome and staged reconstructive surgery in infancy culminating in the Fontan circulation presented to the hospital with a chief complaint of chest pain described as an "elephant sitting" on his chest. Initial 12-lead electrocardiogram revealed 2-mm ST segment elevation in inferior leads, 3-mm ST-segment elevation in anterolateral precordial leads V3 and V4, and 2-mm ST-segment elevation in V5 and V6, with right axis deviation. He was transported emergently to the cardiac catheterization laboratory where coronary angiography revealed complete occlusion of multiple anomalous branches of the right coronary system with hazy appearance suggesting the presence of thrombotic material. An aspiration catheter was used successfully to reestablish TIMI grade III flow. The patient was treated with aspirin, brilinta (ticagrelor), and anticoagulation with vitamin K antagonism to prevent recurrent thromboembolic complications.

Skin rash, eosinophilia, and renal impairment in a patient recently started on allopurinol.

Allopurinol is a hypoxanthine analog which inhibits xanthine oxidase, it is a widely used medication for the treatment of hyperuricemia and gout. Allopurinol-induced drug-induced rash with eosinophilia and systemic symptoms syndrome is an infrequent, life-threatening adverse reaction of allopurinol therapy that is remarkable for the higher mortality rate with the use of allopurinol than with the use of another agent. We present a case of a 62-year-old male with a history of chronic kidney disease stage 3, hypertension and gout who developed skin rash, eosinophilia, and renal impairment 2 weeks after he was started on allopurinol therapy for gout. Allopurinol was stopped, and the patient was started on steroids. This case emphasizes that although allopurinol is commonly used the drug for the treatment of gout. However, it can be associated with serious life-threatening complications. Therefore, care should be taken when prescribing allopurinol, and it should be prescribed only for the appropriate indications.