Double-territory STEMI with cardiogenic shock in immune thrombocytopenic purpura with severe thrombocytopenia-a case report.

Background: Myocardial infarction (MI) in a patient with immune thrombocytopenia is a rare scenario which is very challenging to manage. Case summary: We present a rare case of a patient with immune thrombocytopenic purpura who developed double territory segment-elevation MI with cardiogenic shock. She had an extremely rare presentation with a fresh mobile thrombus in the aortic root which was trap-dooring the right coronary artery ostium and extending into the artery with an embolism into the distal left anterior descending artery. We managed this patient conservatively with excellent recovery owing to the dangerous location of the hanging thrombus, and severe thrombocytopenia. Conclusions: Multidisciplinary approach is required for the management of MI in patients with pre-existing blood disorders, with therapy tailored to the patient's presentation and treatment requirements.

Septal Artery Strangulation Causing Brugada Phenocopy: A Rare Presentation.

Brugada phenocopies are conditions that have an electrocardiography (ECG) pattern that mimics typical patterns seen in Brugada syndrome (BS). We report a rare case of a patient who had a Brugada-like ECG pattern caused by ischemia due to strangulation of the septal artery. The patient was treated with thrombolytic therapy after a probable diagnosis of ST-elevation myocardial infarction (STEMI), which resulted in hematologic complications.

Intractable Heart Failure From a Severe Mitral Paravalvular Leak in Surgically Created Bipartite Left Atrium.

We describe a 38-year-old Middle Eastern woman with a long history of multiple cardiac surgical procedures for mitral valve disease who presented with intractable heart failure from severe mitral paravalvular regurgitation requiring multiple medical admissions since 2019. She was deemed a very high surgical risk and was treated successfully with a percutaneous technique. (Level of Difficulty: Advanced.).

Futuristic robotic percutaneous coronary intervention with innovative physiology optimization: a case report.

Background: Robotic percutaneous coronary intervention (R-PCI) is being preferred over traditional PCI procedures owing to reduced radiation exposure to the personnel performing this technique. However, there are some challenges in using pressure wires in R-PCI. Case summary: This is the first article reporting the usage of pressure wire navigation in R-PCI. We have discussed a case of severe mid-right coronary artery disease, managed with physiology-assisted R-PCI. Software features of R-PCI such as Rotate-On-Retract were effectively used to negotiate Pressure Wire™ X across the tortuous artery. Stenting was successfully carried out with Pressure Wire™ X/R-PCI without any adverse events during or after the procedure. Discussion: Pressure Wire™ X was used with certain modifications to negotiate tortuous arteries. The R-PCI procedure was carried out successfully without any adverse events during or after the procedure.

Arteriolymphatic Fistula: An Extremely Uncommon Adversary and its Management.

A 66-year-old female patient underwent transfemoral coronary angioplasty. Three weeks after the procedure, she presented with abdominal pain. An abdominal computed tomography scan revealed an unusual femoral arteriolymphatic fistula, which was managed with selective angiography-guided glue embolization. (Level of Difficulty: Advanced.).