Unveiling the Heart of the Matter: Intravascular Ultrasound in Acute Myocardial Infarction.

Intravascular ultrasound (IVUS) has become crucial in contemporary percutaneous coronary interventions (PCIs), offering detailed two-dimensional (2D) arterial wall visualization. Current guidelines consider it valuable for guiding coronary stent placement, especially in complex cases like the left main (LM) artery, allowing a comprehensive assessment of vessel characteristics and stent performance. There are some studies that highlight the potential impact of IVUS on acute myocardial infarction (AMI) management, notably improving outcomes. This case involves a 37-year-old man who experienced an AMI, necessitating the use of IVUS to ascertain the underlying cause of his acute coronary syndrome (ACS). This approach was essential for guiding appropriate treatment and ultimately led to successful stent implantation.

Myxedema Coma and the Heart: Would You Miss the Signs?

Myxedema Coma (MC) is a life-threatening medical emergency that occurs as a severe complication of untreated or poorly managed hypothyroidism. Prompt diagnosis is crucial as the condition can rapidly deteriorate and lead to life-threatening complications. Timely treatment of myxedema coma with intravenous levothyroxine is the cornerstone of treatment, along with glucocorticoids to support adrenal function. This condition is associated with cardiovascular manifestations that contribute to its high mortality rate. The heart in hypothyroidism typically shows reversible dysfunction that can be corrected with hormonal supplementation, and in some cases, requires inotropic and aminergic support. This case involves a patient who was admitted to the intensive care unit with suspected MC, and necessitated life-saving hormonal and cardiovascular support to manage the condition.

Assembling the Puzzle: Taking into Account Clinical Presentation and Predictive Scores.

Syncope is a common cause of emergency department visits. Physicians must scrutinize for life-threatening causes to avoid patient morbidity and mortality. Clinical decision rules are used to stratify risks and guide the course of action, including the need for further testing. This is the case of a 83-year-old man was brought to the emergency department after a 5-minute episode of sudden loss of consciousness. Vital signs showed hypotension and physical examination was unremarkable. Despite Wells score of 0, clinical suspicion for pulmonary embolism persisted, for which further testing was pursued. D-dimer was elevated at 13.77 mcg/mL and a chest computed tomography with angiography showed an extensive bilateral pulmonary embolism involving the distal right and left main pulmonary arteries. He was started on full-dose anticoagulation. This case exemplifies the need of high clinical suspicion along with the importance of applying predictive scores for diagnosing unusual causes of syncope.